寰椎侧块枢椎椎弓根螺钉内固定治疗上颈椎骨折相关并发症原因分析及预防  

Complications cause analysis and preventive treatment on lateral mass of the atlas and pedicle screw fixation in cervical fracture

作　　者：于海龙[1] 任伟剑[1] 刘军[1] 杨会峰[1] 孟令志[1] 项良碧[1] 

机构地区：[1]沈阳军区总医院骨科,沈阳110840

出　　处：《中国矫形外科杂志》2014年第16期1462-1465,共4页Orthopedic Journal of China

基　　金：全军医学科学技术研究"十二五"课题(编号:CWS11J209);辽宁省科技计划项目(编号:2012225019)

摘　　要：[目的]探讨寰椎侧块、枢椎椎弓根螺钉内固定术治疗上颈椎骨折相关并发症的原因，并提出对策及预防措施。[方法]回顾性分析自2007年1月～2012年12月本科行寰椎侧块、枢椎椎弓根螺钉内固定术治疗上颈椎骨折并或随访168例，其中男115例，女53例，年龄19～69岁。患病种类包括Jefferson骨折69例，Hangman骨折47例，枢椎齿突骨折52例，对10例手术发生的并发症进行总结分析。[结果]术中、术后并发症共10例，男6例，女4例，内固定位置欠佳2例，椎动脉出血1例，椎动脉栓塞1例，枕大神经痛2例，单纯脑脊液漏2例，脑脊液漏合并椎管内感染、化脓性脑膜炎1例，切口浅表感染1例。内固定位置欠佳者及时行翻修手术，调整内固定螺钉位置，预后良好；椎动脉出血者术中使用骨蜡封闭止血，并拧人椎弓根螺钉压迫止血，术后患者无明显不适主诉；椎动脉栓塞1例：合并小脑梗死，对症治疗后遗留部分功能障碍；枕大神经痛2例：给予激素、脱水、营养神经等对症治疗，术后2个月复查时疼痛明显减轻；单纯脑脊液漏2例：切口紧密缝合，拔除引流管后切口处加压包扎，持续抗生素预防感染，切口愈合良好；脑脊液漏合并椎管内感染、化脓性脑膜炎1例：给予敏感抗生素积极控制感染，预后良好；切口浅表感染1例：经清创缝合术并联合敏感抗生素治疗后痊愈。[结论]寰椎侧块、枢椎椎弓根螺钉内固定术是治疗上颈椎损伤的重要技术，对出现的相应的并发症采用正确、有效的应对措施均可取得良好效果。[ Objective ] To investigate the causes of complications treating upper cervical spinal fracture by atlas lateral mass and axis pedicle screws and put forward countermeasures and preventive measures. [ Method ] We retrospectively studied 168 cases who underwent atlas lateral mass and axis pedicle screws from January 2007 to December 2012, of whom 115 cases were male and 53 cases were female,with the age from 19 to 69 years. The cases included Jefferson fracture in 69 cases,Hang- man fracture in 47 cases, odontoid fracture in 52 cases. The 10 cases of complications of surgery were analyzed. [ Result] Intrao- perative and postoperative complications occurred in 10 cases,including 6 males and 4 females. The complications included the poor internal fixation location in 2 cases, vertebral artery bleeding in 1 case, vertebral artery embolism in 1 case, occipital neural- gia in 2 cases, cerebrospinal fluid leakage in 2 cases, spinal canal infection and purulent meningitis in 1 case, wound infection in 1 case. With the second repair and the regulation of screws, expectant treatment, consecutive treatment with methylprednisolone, dehydrating agent and other drugs, the patient recovered well. The cerebrospinal fluid leakage cases were tackled with sensitive antibiotics, pressure dressing and suturation. The infected cases recovered after consecutive and sensitive antibiotics and sutura- tion. [ Conclusion] Atlas lateral mass and axis pedicle screws is an efficient technique for treating upper cervical spinal frac- ture, it is satisfactory to tackle the complications for proper and effective measures.

关 键 词：寰椎 枢椎 侧块螺钉 椎弓根螺钉 并发症 

分 类 号：R687.3[医药卫生—骨科学]