寰枢椎后路线缆内固定融合术治疗寰枢椎不稳的长期疗效分析  

Long-term clinical results of posterior atlantoaxial cable fixation and fusion for atlantoaxial instability

作　　者：王明飞[1] 纪斌[1] 王健[2] 郭群峰[3] 倪斌[3] 

机构地区：[1]上海中医药大学附属普陀医院骨科,上海200062 [2]武警上海总队医院骨科,上海201103 [3]第二军医大学附属长征医院骨科,上海200003

出　　处：《中国矫形外科杂志》2015年第11期972-975,共4页Orthopedic Journal of China

摘　　要：[目的]评估Gallie及Brooks两种后路寰枢椎固定融合术的长期疗效,并分析影响临床疗效的相关因素。[方法]对1995年2月-2003年6月因寰枢椎不稳行后路线缆内固定融合术的78例患者进行术后随访,记录手术前后JOA评分、颈部疼痛VAS评分、相关并发症、术后头颈胸石膏或颈托外固定使用情况及植骨融合率。并根据具体手术方式分为两组：Gallie及Brooks组,分析两组在植骨融合率方面存在的差异及影响因素。[结果]平均随访期为（86.0±15.0）个月,所有患者随访末期均恢复正常工作,颈部疼痛VAS评分由术前的（7.8±1.5）改善为术后的（0.4±0.8）（P〈0.01）,JOA评分由术前的（16.2±1.7）改善为术后的（16.8±0.7）（P〈0.01）。3例术后发生神经并发症,均为齿突游离小骨病例;其中2例行Gallie融合术,为术前脊髓症状加重;1例行Brooks融合术,为新出现的脊髓症状;所有患者均保守治疗后治愈,未遗留永久性神经功能损害。5例出现植骨不愈合,其中Gallie融合术3例,Brooks融合术2例,均行翻修后融合,两种融合方法融合率差异无统计学意义（P〉0.05）。齿状突游离小骨与齿状突骨折在融合率方面差异也无统计学意义（P〉0.05）。[结论]对于齿状突骨折,后路线缆结扎内固定技术结合颈托固定就能够满足固定要求;而对于类风湿性关节炎或齿突游离小骨引起的寰枢椎不稳施行后路线缆结扎内固定技术附加坚强外固定也可以达到满意的手术疗效。[ Objective] To evaluate the long term results of Gallic and Brooks techniques in the treatment of atlantoaxial instability and analyze the factors influencing the clinical results. [ Methods] A retrospective review of 78 patients who under- went atlantoaxialeable fixation and fusion for atlantoaxial instabilityfrom 1995 to2003 was carried out. The JOA score, visual ana- log scale （VAS） neck, bone fusion and complications were recorded. The record of postoperative employment of collar and chest neck plaster was reviewed. The difference in bone fusion rate between Gallic technique and Brooks technique was analyzed. [ Results] The mean follow - up was （ 86.0 ± 15.0 ） months. At the final follow up, all patients returned to normal work. The VAS neck was reduced to （0. 4 ± 0. 8 ） from preoperative （7.8 ± 1.5 ） （ P 〈0. 01 ） and the JOA score was improved from pre- operative （ 16.2 ± 1.7 ） to （ 16. 8 ± 0. 7 ） （ P 〈 0.01 ） . Neurological deficits developed in 3 patients with osodontoideum. Two of them underwent Gallic technique and one Brooks technique. The neurological function was recovered after expectant treatment without eternal neurological deficits. Non - fusion was observed in 5 cases. Three cases underwent Gallic technique and 2 Brooks technique. All of them need a second surgery and bone fusion was finally obtained. There was no significant difference in bone fu- sion rate between Gallic technique and Brooks technique （ P 〉 0.05 ） . And no significant difference was observed in bone fusion rate between cases with odontoid fracture and that with osodontoideum （P 〉 0.05 ） . [Conclusion] Odontoid fractures may be successfully managed by a posterior cable fixation and fusion technique with postoperative collar wearing. Rheumatoid atlantoaxial instability may be managed by posterior cable fixation and fusion technique supplemented with solid external immobilization.

关 键 词：寰枢椎脱位 寰枢椎融合 长期疗效 

分 类 号：R687.3[医药卫生—骨科学]