颈后路椎弓根钉棒短节段内固定治疗寰枢椎骨折脱位
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作者Author单位AddressE-Mail
张红星 ZHANG Hong-xing 河南省洛阳正骨医院河南省骨科医院脊柱外一科, 河南 洛阳 471000 The First Department of Spinal Surgery, Luoyang Orthopedic Hospital of Hennan Province, Henan provincial Orthopedic Hospital, Luoyang 471000, Henan, China wangh778@163.com 
朱言 ZHU Yan 河南省洛阳正骨医院河南省骨科医院脊柱外一科, 河南 洛阳 471000 The First Department of Spinal Surgery, Luoyang Orthopedic Hospital of Hennan Province, Henan provincial Orthopedic Hospital, Luoyang 471000, Henan, China  
史相钦 SHI Xiang-qin 河南省洛阳正骨医院河南省骨科医院脊柱外一科, 河南 洛阳 471000 The First Department of Spinal Surgery, Luoyang Orthopedic Hospital of Hennan Province, Henan provincial Orthopedic Hospital, Luoyang 471000, Henan, China  
期刊信息:《中国骨伤》2023年,第36卷,第5期,第490-494页
DOI:10.12200/j.issn.1003-0034.2023.05.018
基金项目:
中文摘要:

目的:探讨颈后路椎弓根钉棒短节段内固定治疗寰枢椎骨折脱位的临床疗效。

方法:对2015年1月至2018年1月手术治疗的60例寰枢椎骨折脱位患者进行回顾性分析,根据手术方法的不同分为研究组和对照组,其中研究组30例,男13例,女17例;年龄(39.32±2.85)岁;行颈后路椎弓根钉棒短节段内固定术。对照组30例,男12例,女18例;年龄(39.57±2.90)岁;行寰椎后路椎板夹内固定。记录两组患者手术时间、术中出血量、术后下床活动时间和住院时间以及并发症,观察两组患者疼痛视觉模拟评分(visual analogue scale,VAS),神经功能日本骨科协会(Japanese Orthopedic Association,JOA)评分及融合情况。

结果:两组患者均获得至少12个月随访。研究组手术时间、术中出血量、术后下床活动时间及住院时间均优于对照组(P=0.000)。研究组发生呼吸道损伤1例;对照组发生切口感染2例,呼吸道损伤3例,相邻节段关节退变3例;研究组并发症发生率低于对照组(χ2=4.705,P=0.030)。术后1、3、7 d,研究组VAS低于对照组(P=0.000);术后1、3个月时,研究组JOA评分高于对照组(P=0.000)。术后12个月研究组患者均获得骨性融合;对照组出现3例骨性融合不佳,3例内固定断裂,发生率为20.00%(6/30);两组差异有统计学意义(χ2=4.629,P=0.031)。

结论:颈后路椎弓根钉棒短节段内固定治疗寰枢椎骨折脱位具有创伤小、手术时间短、并发症少、疼痛程度轻等优势,且可促使神经功能尽快恢复。
【关键词】颈寰椎  枢椎,颈椎  骨折  脱位  骨折固定术,内
 
Posterior cervical pedicle screw rod short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation
ABSTRACT  

Objective To investigate the clinical efficacy of posterior cervical pedicle screw short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation.

Methods The clinical data of 60 patients with atlantoaxial vertebral fracture and dislocation underwent surgery between January 2015 and January 2018 were retrospectively analyzed. The patients were divided into study group and control group according to different surgical methods. There were 30 patients in study group,including 13 males and 17 females,with an average age of (39.32±2.85) years old,were underwent short-segment internal fixation with posterior cervical pedicle screws. There were 30 patients in control group,including 12 males and 18 females,with an average age of (39.57±2.90) years old,were underwent posterior lamina clip internal fixation of the atlas. The operation time,intraoperative blood loss,postoperative ambulation time,hospitalization time and complications between two groups were recorded and compared. The pain visual analogue scale(VAS),Japanese Orthopedic Association(JOA) score of neurological function,and fusion status were evaluated between two groups.

Results All patients were followed up for at least 12 months. The study group was better than control group in operation time,intraoperative blood loss,postoperative off-bed activity time,and hospital stay (P=0.000). One case of respiratory tract injury occurred in study group. In control group,2 cases occurred incision infection,3 cases occurred respiratory tract injury,and 3 cases occurred adjacent segmental joint degeneration. The incidence of complications in study group was lower than that in control group (χ2=4.705,P=0.030). At 1,3,7 days after operation,VAS of study group was lower than that of control group(P=0.000). At 1,3 months after operation,JOA score of study group was higher than that of control group(P=0.000). At 12 months after operation,all the patients in the study group achieved bony fusion. In control group,there were 3 cases of poor bony fusion and 3 cases of internal fixation fracture,the incidence rate was 20.00%(6/30). The difference between two groups was statistically significant (χ2=4.629,P=0.031).

Conclusion Posterior cervical short-segment pedicle screw fixation for atlantoaxial fracture and dislocation has the advantages of less trauma,shorter operation time,fewer complications,and less pain,and can promote the recovery of nerve function as soon as possible.
KEY WORDS  Cervical atlas  Axis,cervical vertebra  Fractures  Dislocations  Fracture fixation,internal
 
引用本文,请按以下格式著录参考文献:
中文格式:张红星,朱言,史相钦.颈后路椎弓根钉棒短节段内固定治疗寰枢椎骨折脱位[J].中国骨伤,2023,36(5):490~494
英文格式:ZHANG Hong-xing,ZHU Yan,SHI Xiang-qin.Posterior cervical pedicle screw rod short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(5):490~494
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