| 上颈椎不稳前路内固定方式的选择 |
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Received:December 13, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 黄卫兵 |
HUANG Wei-bing |
广州军区武汉总医院骨科, 湖北 武汉 430070 |
Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of PLA, Wuhan 430070, Hubei, China |
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| 蔡贤华 |
CAI Xian-hua |
广州军区武汉总医院骨科, 湖北 武汉 430070 |
Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of PLA, Wuhan 430070, Hubei, China |
wgcaixh@163.com |
| 陈庄洪 |
CHEN Zhuang-hong |
广州军区武汉总医院骨科, 湖北 武汉 430070 |
Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of PLA, Wuhan 430070, Hubei, China |
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| 黄继锋 |
HUANG Ji-feng |
广州军区武汉总医院骨科, 湖北 武汉 430070 |
Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of PLA, Wuhan 430070, Hubei, China |
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| 刘曦明 |
LIU Xi-ming |
广州军区武汉总医院骨科, 湖北 武汉 430070 |
Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of PLA, Wuhan 430070, Hubei, China |
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| 魏世隽 |
WEI Shi-jun |
广州军区武汉总医院骨科, 湖北 武汉 430070 |
Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of PLA, Wuhan 430070, Hubei, China |
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| 期刊信息：《中国骨伤》2013年26卷，第7期，第572-577页 |
| DOI：10.3969/j.issn.1003-0034.2013.07.010 |
| 基金项目:全军医学科学技术研究“十一五”攻关课题(编号:08G031);武汉科技局科技攻关课题(编号:201260523184) |
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目的: 探讨上颈椎不稳前路内固定手术方式的选择及治疗效果。
方法: 自2000年3月至2010年9月,采用寰枢椎前路内固定手术治疗上颈椎不稳83例,男59例,女24例;年龄20～68岁,平均42岁。其中齿状突螺钉内固定36例,寰枢椎前路经关节螺钉内固定16例,C2,3前路钢板内固定23例,齿状突螺钉联合寰枢椎经关节螺钉内固定5例,齿状突螺钉联合C2,3钢板内固定2例,寰枢椎经关节螺钉联合C2,3钢板内固定1例。
结果: 1例颈脊髓完全损伤患者,行寰枢椎经关节螺钉内固定,术后1个月死于肺部感染。其余病例获得随访,时间8个月～3年,平均15个月。无椎动脉及脊髓损伤,所有病例寰枢椎获得稳定。36例齿状突螺钉内固定及5例齿状突联合寰枢椎经关节螺钉内固定者,未植骨,齿状突骨性愈合。寰枢椎经关节螺钉内固定病例:1例并发肺部感染死亡;1例齿状突ⅡC型粉碎性骨折并寰枢关节前脱位,齿状突及植骨未骨性愈合,但寰枢关节纤维连接无不稳定表现;1例寰枢椎陈旧性前脱位Ⅰ期前路寰枢椎经关节螺钉内固定,Ⅱ期后路Brooks钢丝内固定后路植骨,寰枢椎骨性融合。其他病例均植骨并获骨性融合。
结论: 上颈椎不稳患者,根据不同的骨折及不稳类型,选择相应的前路内固定,可取得较好疗效。 |
| [关键词]:颈椎 关节不稳定性 外伤 外科手术 |
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| Surgical strategy for upper cervical vertebrae instability through the anterior approach |
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Abstract:
Objective: To explore the choice and effect of internal fixation in treating upper cervical vertebrae instability through anterior approach.
Methods: From March 2000 to September 2010,83 patients with upper cervical vertebrae instability were treated with internal fixation through anterior approach. There were 59 males and 24 females with a mean age of 42 years old (ranged,20 to 68). Among these patients,36 patients were treated with odontoid screw fixation,16 patients with C1,2 transarticular screw fixation,23 patients with C2,3 steel plate fixation,5 patients with odontoid screw and transarticular screw fixation,2 patients with odontoid screw and C2,3 steel plate fixation,1 patient with C1,2 transarticular screw and C2,3 steel plate fixation.
Results: One patient with completely cervical vertebrae cord injury died of pulmonary infection after C1,2 transarticular screw fixation. Other patients were followed up from 8 to 36 months with an average of 15 months. Upper cervical vertebrae stability were restored without vertebral artery and spinal cord injury. Thirty-six patients were treated with odontoid screw fixation and 5 patients were treated with screw combined with transarticular screw fixation obtained bone union in the dentations without bone graft. Among the 16 patients treated with C1,2 transarticular screw fixation,13 patients obtained bone union after bone graft;1 patient died of pulmonary infection after surgery;1 patient with comminuted odontoid fracture of type ⅡC and atlantoaxial anterior dislocation did not obtain bone union after bone graft,but the fibrous healing was strong enough to maintain the atlantoaixal joint stability;1 patient with obsolete atlantoaxial anterior dislocation were re-treated with Brooks stainless steel wire fixation and bone graft through posterior approach,and finally obtained bone union.
Conclusion: It could obtain satisfactory effects depending on the difference of cervical vertebrae instability to choose the correctly surgical method. |
| KEYWORDS:Cervical vertebrae Joint instability Trauma Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 黄卫兵,蔡贤华,陈庄洪,黄继锋,刘曦明,魏世隽.上颈椎不稳前路内固定方式的选择[J].中国骨伤,2013,26(7):572~577 |
| 英文格式: | HUANG Wei-bing,CAI Xian-hua,CHEN Zhuang-hong,HUANG Ji-feng,LIU Xi-ming,WEI Shi-jun.Surgical strategy for upper cervical vertebrae instability through the anterior approach[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(7):572~577 |
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