| 后路钛缆与钢丝内固定治疗少儿寰枢椎不稳的临床对照试验 |
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投稿时间：2007-05-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 曹锡文 |
CAO Xi-wen |
湘南学院附属医院骨科,湖南郴州423000 |
Department of Orthopaedics,the Affiliated Hospital of Xiangnan College,Chenzhou 423000,Hunan,China |
liudoct@163.com |
| 刘文和 |
LIU Wen-he |
湘南学院附属医院骨科,湖南郴州423000 |
Department of Orthopaedics,the Affiliated Hospital of Xiangnan College,Chenzhou 423000,Hunan,China |
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| 胡伟文 |
HU Wei-wen |
湘南学院附属医院骨科,湖南郴州423000 |
Department of Orthopaedics,the Affiliated Hospital of Xiangnan College,Chenzhou 423000,Hunan,China |
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| 李杨 |
LI Yang |
湘南学院附属医院骨科,湖南郴州423000 |
Department of Orthopaedics,the Affiliated Hospital of Xiangnan College,Chenzhou 423000,Hunan,China |
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| 陈鹏 |
CHEN Peng |
湘南学院附属医院骨科,湖南郴州423000 |
Department of Orthopaedics,the Affiliated Hospital of Xiangnan College,Chenzhou 423000,Hunan,China |
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| 郭志文 |
GUO Zhi-wen |
湘南学院附属医院骨科,湖南郴州423000 |
Department of Orthopaedics,the Affiliated Hospital of Xiangnan College,Chenzhou 423000,Hunan,China |
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| 王福剑 |
WANG Fu-jian |
湘南学院附属医院骨科,湖南郴州423000 |
Department of Orthopaedics,the Affiliated Hospital of Xiangnan College,Chenzhou 423000,Hunan,China |
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| 期刊信息：《中国骨伤》2007年，第20卷，第12期，第812-814页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目: |
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中文摘要:
目的:探讨后路钛缆与钢丝治疗少儿寰枢椎不稳的疗效。
方法:63例15岁以下寰枢椎不稳患者,男38例,女25例。分别行后路钛缆固定（32例）,钢丝内固定（31例）,均采用颗粒状自体松质骨植骨的寰枢椎后路融合术治疗。术后对两组手术时间、出血量、骨性融合时间、术后骨性融合病例数疗效进行比较。
结果:手术时间:钢丝固定组（110±35.6）min,钛缆固定组（70±25.4）min,两组差异有统计学意义（t=6.205 4,P<0.05）。手术出血量:钢丝固定组（160±55.8）ml,钛缆固定组（120±35.3）ml,两组差异有统计学意义（t=6.235 7,P<0.05）。63例患者均获随访,随访时间3.2~12.9个月,平均6.1个月。术后骨性融合时间:钢丝固定组（3.8±0.3）个月,钛缆固定组（3.1±0.2）个月,两组差异无统计学意义（t=2.314 4,P>0.05）。钢丝固定患者中钢丝断裂4例,钢丝松脱2例,25例获骨性融合;钛缆固定患者中钛缆松脱1例,31例获骨性融合,未发生钛缆断裂、脊髓损伤等其他并发症。术后骨性融合病例数两组差异有统计学意义（2χ=4.199 4,P<0.05）。按疗效评定标准,钛缆固定组,优21例,良10例,可1例,差0例;钢丝固定组,优14例,良11例,可4例,差2例,两组差异有统计学意义（u=5.134 2,P<0.05）。
结论:钛缆内固定具有手术时间短、术中出血少、并发症少等优点,是后路治疗少儿寰枢椎不稳的一种更为理想的方法。 |
| 【关键词】寰枢关节 关节不稳定性 骨科手术方法 临床对照试验 |
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| Treatment of atlanto-axial instability with atlanto-axial arthrodesis combined with different posterior internal fixation system in children |
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ABSTRACT
Objective:To evaluate retrospectively the outcomes of the treatment of atlanto-axial instability with titanium cable and steel wire for atlanto-axial instability in children.
Methods:Sixty-three patients no more than 15 years old(38 male and 25 female) suffered from atlanto-axial instability were divided into 2 groups according to the use of different posterior internal fixation system.Steel wire group included 31 patients were managed by atlanto-axial arthrodesis combined with posterior internal fixation with steel wire and granulated autogenous cancellous bone graft;titanium cable group included 32 patients were managed by atlanto-axial arthrodesis combined with posterior internal fixation with titanium cable and granulated autogenous cancellous bone graft.The evaluation was made based on the average operative time,the average amount of bleeding in operation,the average time to solid osseous fusion and the cases with solid osseous fusion.
Results:The average operative time was(110±35.6) min in steel wire group,(70±25.4) min in titanium cable group.The differences in the average operative time had statistical significance(t=6.205 4,P<0.05) between titanium cable group and steel wire group.The average amount of bleeding in operation was(160±55.8) ml in steel wire group,(120±35.3) ml in titanium cable group.The differences in the average amount of bleeding in operation had statistical significances(t=6.235 7,P<0.05) between titanium cable group and steel wire group.All the patients had been followed-up with an average duration of 6.1 months(ranging from 3.2 to 12.9 months).The average time to solid osseous fusion was(3.8±0.3) months in steel wire group,(3.1±0.2) months in titanium cable group.The differences in the average time to solid osseous fusion between titanium cable group and steel wire group had no statistical significances(t=2.314 4,P>0.05).In the 31 patients with steel wire fixation,several kinds of complications occurred,such as broken in 4 cases,loosening of steel wires in 2 cases,graft fusion succeeded in 25 cases without complications;while in the 32 patients with titanium cable fixation,loosening of titanium cable occurred in 1 case,graft fusion succeeded in 31 cases without any complications such as cord injury,cable loosening and broken,and so on.The differences of the cases with solid osseous fusion between titanium cable group and steel wire group had statistical significances(P<0.05).According to the effect of treatment,the result was excellent in 21 patients,good in 10,fair in 1 in titanium cable group and excellent in 14,good in 11,fair in 4,poor 2 in steel wire group.The differences between titanium cable group and steel wire group had statistical significances(u=5.134 2,P<0.05).
Conclusion:Posterior internal fixation with titanium cable and granulated autogenous cancellous bone graft is more effective than posterior internal fixation with steel wire and granulated autogenous cancellous bone graft and it has some advantages such as shorter average operative time,less average amount of bleeding in operation and less operative complications,so it is suitable for the treatment of atlanto-axial instability in children. |
| KEY WORDS Atlanto-axial joint Joint instability Orthopaedics operative methods Controlled clinical trials |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 曹锡文,刘文和,胡伟文,李杨,陈鹏,郭志文,王福剑.后路钛缆与钢丝内固定治疗少儿寰枢椎不稳的临床对照试验[J].中国骨伤,2007,20(12):812~814 |
| 英文格式: | CAO Xi-wen,LIU Wen-he,HU Wei-wen,LI Yang,CHEN Peng,GUO Zhi-wen,WANG Fu-jian.Treatment of atlanto-axial instability with atlanto-axial arthrodesis combined with different posterior internal fixation system in children[J].zhongguo gu shang / China J Orthop Trauma ,2007,20(12):812~814 |
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