后路椎弓根螺钉内固定融合术治疗创伤性寰枢椎不稳  

Treatment of traumatic atlantoaxial instability via posterior internal fixation and fusion plus atlantoaxial pedicle screw

作　　者：王守国[1] 徐用亿[1] 谢跃[1] 费昊东[1] 季峰[1] 赵庆华[2] 田纪伟[2] 

机构地区：[1]南京医科大学附属淮安第一医院,淮安223300 [2]上海交通大学附属第一人民医院,上海200080

出　　处：《中国矫形外科杂志》2011年第16期1332-1335,共4页Orthopedic Journal of China

摘　　要：[目的]探讨经后路椎弓根螺钉系统内固定融合术治疗创伤性寰枢椎不稳的临床疗效。[方法]回顾2008年3月-2010年10月,采用后路椎弓根钉系统固定融合治疗创伤性寰枢椎不稳20例,男14例,女6例;平均年龄39.6岁;Jefferson骨折4例,Ⅱ型齿状突骨折5例,齿状突骨折合并寰枢椎脱位3例,Jefferson骨折合并齿状突骨折1例,寰枢椎脱位7例。采用JOA（Japanese Orthopaedic Association,JOA）颈椎评分标准和VAS（visual analoguescale,VAS）评分标准评价治疗效果。[结果]手术时间（138.75±20.06）min,术中出血量（338.80±100.10）ml,术后随访12-25个月,平均随访15.56个月,所有患者均取得了骨性融合,无内固定松动断裂;VAS评分从术前（7.25±1.52）分降至末次随访（2.13±1.75）分,差异有统计学意义（P〈0.01）;JOA评分从术前（8.65±3.49）分提高至（13.05±4.88）分,差异有统计学意义（P〈0.01）,改善率为（58.01±20.15）%。[结论]后路椎弓根螺钉棒系统内固定融合术治疗创伤性寰枢椎不稳具有操作相对简便、固定牢固、融合率高等优势,是一种安全有效的治疗方法。[Objective]To study the therapeutic effect of posterior fixation and fusion plus pedicle screw in treatment of traumatic atlantoaxial instability.[Method]A retrospective analysis was done on twenty patients（14 male and 6 female,mean age of 39.6 years old）with traumatic atlantoaxial instability treated via atlantoaxial pedicle screw system from March 2008 to October 2010,included 4 cases with Jefferson fracture,5 cases with type-Ⅱ Dens fracture,3 cases with Dens fracture combined with atlantoaxial dislocation,1 case with Jefferson fracture combined with Dens fracture,7 cases with atlantoaxial dislocation.The post-operative effect was evaluated with JOA（Japanese Orthopaedic Association）scores and VAS（visual analogue scale）.[Result]Operative time were 138.75±20.06 min,and blood loss were 338.80±100.10 ml.All patients received the follow-up（range from 12 to 25 months,mean 15.6 months）.All atlantoaxial joint came to bony fusion by the last follow-up without complication due to instrumentation.There was significant difference on VAS scores between pre-operation（7.25±1.52） and post-operation（2.13±1.75）（P〈0.01）.There was significant difference on JOA scores between pre-operation（8.65±3.49） and post-operation（13.05±4.88）（P〈0.01）,and improvement rate was 58.01±20.15%.[Conclusion]Posterior fixation and fusion plus pedicle screw has the advantages of strong fixation,direct screw placement,and high fusion rate in traumatic atlantoaxial instability.So it is a better alternative for traumatic atlantoaxial instability.

关 键 词：寰枢椎不稳 椎弓根螺钉 内固定 融合 

分 类 号：R687.3[医药卫生—骨科学]