颈枕区融合术的并发症分析  

Complications After Fusion of Cervico-occipital Region

作　　者：郝定均[1] 贺宝荣[1] 雷伟[2] 周劲松[1] 孙宏慧[3] 吴起宁[1] 

机构地区：[1]西安市红十字会医院脊柱外科,710054 [2]第四军医大学西京医院骨科,710032 [3]第四军医大学唐都医院骨科,710038

出　　处：《美中国际创伤杂志》2008年第1期1-5,共5页U.S.Chinese International Journal of Traumatology

摘　　要：目的：总结颈枕区融合术的并发症，探索其防治策略。方法：回顾性分析1985年1月-2003年1月颈枕区融合318例患者，术后出现各种并发症43例。298例获得随访，随访1年6个月～18年，平均6年8个月。单纯融合组分别应用枕骨骨瓣翻转、自体髂骨融合。融合内固定组依据疾病类型选择适当的融合方法，以及恰当的内固定器械。结果：单纯融合组45例，并发症11例，发生率24．4％，融合内固定组273例，并发症32例，发生率为11．7％，差异显著（X^2=5．16，P〈0．05）。融合内固定组Cervifix和Axis螺钉方向不佳分别占固定侧块螺钉的0．73％和4．08％，差异显著（X^2=9．35，P〈0．01）。神经根损伤分别为0．49％和3．40％，差异显著（X^2=8．67，P〈0．01）。螺钉退出分别为0．24％和3．06％，差异显著（X^2=9．70，P〈0．011。椎动脉损伤分别为0．24％和1．70％，差异显著（X^2=4．30，P〈0．05）。结论：颈枕区融合术可发生多种并发症，恰当的处理预后良好。熟悉解剖、掌握技巧是减少并发症的前提，正确内固定系统的选择可减少并发症的发生。Objective： To study the prevention and treatment of complications after cervico-occipital region fusion. Methods： From January 1985 to January 2003, 318 patients underwent fusion at cervico-occipital region and were retrospectively analyzed. 43 of them appeared complications postoperatively. 298 of them were followed up from 18 months to 18 years （average 6 years and 8 months）. Occipital bone valve inversion and iliac fusion were performed in simple fusion group （45 cases）. Appropriate fusion method and well-suited internal fixation device were selected in internal fixation group （273 cases） according to the type of disease. Results： The incidence of complications was 24.4% （11 cases） in fusion group and 11.7% （32 cases） in fixation （Cervifix and Axis screws） group, the difference was significant （X^2=5.16, P〈0.05）. Between Cervifix fixation and Axis fixation, the incidence of screws in wrong direction, nerve root injury, screw extraction and vertebral artery injury respectively was 0.73%, 0.49%, 0.24%, 0.24% and 4.08%, 3.40%, 3.06%, 1.70% with a significant difference （X^2=9.35, P〈0.01）; （X^2=8.67, P〈0.01）; （X^2=9.70, P〈0.01）; （X^2=4.30, P〈0.05）. Conclusion： Cervico-occipital region fusion may result in many complications. Premise to reduce the complications is to have an intimate knowledge of the anatomy and palmar grasp the skill. Appropriate internal fixation also can reduce the complications.

关 键 词：上颈椎 外科治疗 颈枕融合 内固定 并发症 

分 类 号：R683.2[医药卫生—骨科学]