后路显微内窥镜辅助下经椎弓根内固定治疗创伤性寰枢椎不稳  

SPINAL PEDICLE SCREW INTERNAL FIXATION THROUGH ENDOSCOPE-ASSISTED POSTERIOR APPROACH FOR TREATMENT OF TRAUMATIC ATLANTOAXIAL INSTABILITY

作　　者：韦文[1] 肖增明[2] 陆文忠[1] 麦荫文[1] 黄承夸[1] 华树良[1] 

机构地区：[1]百色市人民医院脊柱外科,广西百色533000 [2]广西医科大学第一附属医院脊柱骨病外科

出　　处：《中国修复重建外科杂志》2012年第11期1324-1329,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广西卫生厅自筹经费科研课题资助项目(Z2011072)~~

摘　　要：目的探讨后路显微内窥镜辅助下经椎弓根内固定治疗创伤性寰枢椎不稳的可行性及临床效果。方法 2008年9月-2010年9月,收治创伤性寰枢椎不稳患者44例,随机分为微创组及传统治疗组,每组22例。两组性别、年龄、损伤类型、病程及术前日本骨科协会(JOA)评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。微创组在显微内窥镜辅助下,行后路复位、经寰枢椎椎弓根螺钉内固定治疗;传统治疗组按常规手术方法行寰枢椎椎弓根螺钉内固定治疗。通过观察两组手术时间、术中出血量、手术切口长度、JOA评分改善率、植骨融合等指标评价手术效果。结果微创组手术时间、术中出血量、手术切口长度均优于传统治疗组,差异有统计学意义(P<0.05)。两组手术切口均Ⅰ期愈合,无感染等并发症发生。微创组和传统治疗组分别有7枚和8枚螺钉穿入横突孔内壁,均无椎动脉损伤表现。两组均获随访,随访时间12～37个月,平均26个月。两组植骨均融合,融合时间3～12个月,平均5.3个月;无内固定物松动、断裂等并发症发生。两组共6例于术后6个月～1年取出临时内固定物,头颈部旋转功能未受明显影响。两组末次随访时JOA评分均较术前显著改善(P<0.05),两组间JOA评分及改善率比较差异均无统计学意义(P>0.05)。结论后路显微内窥镜辅助下经椎弓根内固定既具有传统方法术后即刻恢复稳定、融合率高、并发症较少的特点,又具有微创手术出血少、软组织损伤小等优点,是治疗创伤性寰枢椎不稳较理想的内固定方式。Objective To explore the feasibility and effectiveness of spinal pedicle screw internal fixation through endoscope-assisted posterior approach for the treatment of traumatic atlantoaxial instability.Methods Between September 2008 and September 2010,44 patients with traumatic atlantoaxial instability received spinal pedicle screw internal fixation through endoscope-assisted posterior operation（micro-invasive surgical therapy group,n=22） or traditional surgical therapy（control group,n=22）.There was no significant difference in gender,age,type of injury,disease duration,and preoperative Japanese Orthopedic Association（JOA） score between 2 groups（P 0.05）.The blood loss,operation time,length of the incision,improvement rate of JOA,and graft fusion rates were compared between 2 groups to assess the clinical outcomes.Results The blood loss,operation time,and length of the incision in the micro-invasive surgical therapy group were better than those in control group（P 0.05）.All incisions were primary healing.Of 88 pedicle screws,7 pedicle screws penetrated into the interior walls of cervical transverse foramen in the micro-invasive surgical therapy group and 8 in the control group,but there was no syndrome of vertebral artery injury.All patients of the 2 groups were followed up 12 to 37 months（mean,26 months）.Bony fusion was achieved in all cases within 3 to 12 months（mean,5.3 months）.No loosening or breakage of screw occurred.At 6 months to 1 year after operation,the internal fixator was removed in 6 cases and the function of head and neck rotary movement were almost renewed.The JOA score was significantly improved at last follow-up when compared with preoperative score（P 0.05）,and no significant difference in JOA score and improvement rate between the 2 groups at last follow-up（P 0.05）.Conclusion The micro-invasive surgical therapy can acquire the same effectiveness to the traditional surgical therapy in immediate recovery of stability,high graft fusion rate,and less complication.More

关 键 词：创伤性寰枢椎不稳 内窥镜 脊柱融合术 脊柱微创手术 

分 类 号：R687.3[医药卫生—骨科学]