单边寰枢椎椎弓根螺钉加结构性植骨治疗不稳定寰椎骨折  

Unilateral atlantoaxial pedicle screw fixation plus structural iliac bone graft for treatment of unstable atlas fractures

作　　者：张国旺[1] 连小峰[1] 杨二柱[1] 曹亮亮[1] 梁博[1] 徐建广[1] Zhang Guowang Lian Xiaofeng Yang Erzhu Cao Liangliang Liang Bo Xu fianguang.(Department of Orthopedics, Affiliated Sixth People＇s Hospital of Shanghai Jiaotong University, Shanghai 200233, Chin)

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤杂志》2017年第7期627-633,共7页Chinese Journal of Trauma

摘　　要：目的探讨单边寰枢椎椎弓根螺钉固定加髂骨块植骨融合术治疗不稳定寰椎骨折伴一侧椎弓根发育不良或粉碎性骨折的疗效。方法采用回顾性病例对照研究分析2012年1月-2016年6月收治的44例不稳定寰椎骨折患者临床资料。根据手术方式不同分为两组：A组22例，为不稳定寰椎骨折合并寰枢椎一侧椎弓根发育不良或粉碎性骨折，其中男15例，女7例；年龄（37．5±13．4）岁；采用单边寰枢椎椎弓根螺钉固定加髂骨块植骨融合术治疗。B组22例，为不稳定寰椎骨折，未合并寰枢椎一侧椎弓根发育不良或粉碎性骨折，其中男14例，女8例；年龄（38．1±13．3）岁；采用双边寰枢椎椎弓根螺钉固定加髂骨块植骨融合治疗。比较两组手术时间、术中出血量、住院时间、椎弓根螺钉置入成功率、术后寰枢椎稳定性及手术并发症；术前、术后6个月、末次随访均进行视觉模拟评分（VAS）和日本骨科学会（JOA）评分；比较两组植骨融合情况。结果患者均获随访14～48个月，平均28．4个月。A组手术时间（123．4±18．2）min，术中出血量（218．5±80．2）ml，住院时间（7．1±1．0）d，椎弓根螺钉置入成功率100％，寰枢椎稳定性得到即刻恢复，未出现术后并发症。B组手术时间（173．4±12．4）min，术中出血量（318．2±61．7）ml，住院时间（7．2±0．8）d，椎弓根螺钉置入成功率100％，寰枢椎稳定性得到即刻恢复，未出现术后并发症。两组手术时间、术中出血量差异均有统计学意义（P〈0．01），住院时间、螺钉置入成功率、并发症发生率、VAS及JOA评分差异均无统计学意义（P〉0．05）。结论与双边寰枢椎椎弓根螺钉固定加髂骨块植骨融合术比较，单边寰枢椎椎弓根螺钉固定加髂骨块植骨融合术治疗不稳定寰椎骨折伴一侧椎弓根发育不良或粉碎性骨折的疗效相近，但可缩短手术Objective To evaluate the efficacy of unilateral atlanto-axial transpedicle screw fixation plus iliac bone graft for treatment of unstable atlas fractures combined with unilateral pedicle dysp]asia or comminuted fractures. Methods A retrospective case control study was made on 44 patients with unstable atlas fractures surgically treated between January 2012 to June 2016. Unilateral atlanto-axial transpedicle screw fixation combined with iliac bone graft was performed for 22 patients combined with unilateral pedicle dysplasia or eonmfinuted fractures in Group A[ 15 males, seven females; （37.5 ＋-13.4 ）years ], and bilateral atlanto-axial transpedicle screw fixation combined with iliac bone graft was performed for 22 patients without unilateral pedicle dysplasia or comminuted fractures in Group B [ 14 males, eight females; （38.1 ± 13.3）years ]. Between-group differences were compared concerning operation time,intraoperative blood loss, length of hospital stay, success rate of screw placement, postoperative atlanto- axial stability, surgery-related complications, visual analog scale （VAS）, Japanese orthopedic association score （JOA） and bone fusion. Results Mean duration of follow-up was 28.4 months （range, 14- 48 months）. In Group A, operation time was （ 123.4 ± 18.2） min, blood loss was （218.5± 80.2） ml, hospital stay was （7.1 ± 1.0）d, success rate of screw placement was 100% , postoperative atlanto-axial stability of all patients was obtained, and no complications occurred. In Group B, operation time was （ 173.4 ± 12.4） min, blood loss was （ 318.2 ± 61.7 ） ml, hospital stay was （7.2±0.8 ） d, success rate of screw placement was 100%, postoperative atlanto-axial stability of all patients was obtained, and no complications occurred. There were significant differences in operation time and blood loss between the two groups （P 〈 0.01 ）, while not in hospital stay, success rate, postoperative atlant-oaxial stability, complication incidence, VAS and JOA （ P 〉

关 键 词：寰枕关节 脊柱骨折 脊柱融合术 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]