经口咽微型钢板与后路钉板单节段内固定治疗不稳定型Jefferson骨折的疗效比较  

A comparison of effects of transoral mini plate and posterior nail plate single segment fixation in the treatment of Jefferson fractures

作　　者：赵朵 李小峰 农桔安 杨渊 ZHAO Duo;LI Xiao-feng;NONG Ju-an;YANG Yuan(Guangxi Medical University, Nanning,Guangxi, 530021, China)

机构地区：[1]广西医科大学,南宁530021 [2]广西骨伤医院,南宁530012 [3]广西医大开元琅东医院,南宁530000

出　　处：《中国骨与关节杂志》2018年第6期407-412,共6页Chinese Journal of Bone and Joint

摘　　要：目的分析经口咽及后入路单节段治疗不稳定型Jefferson骨折的临床疗效并进行比较。方法选取2012年4月至2016年10月,笔者治疗的36例不稳定型寰椎骨折患者作为研究对象,根据手术方式不同分成A、B两组进行回顾性分析,A组(n=16)采用经口咽单节段微型钢板寰椎骨折复位固定术,B组(n=20)采用后入路单节段钉板寰椎骨折内固定术,随访并比较两组术前与术后的R-J距离(寰椎椎体下缘连线中点到基底线的垂直距离)、疼痛视觉模拟评分(visual analogue scale,VAS)、出血量、手术时间、术后并发症、Frankel分级以及术后颈椎活动度;另外在广西医科大学第一附属医院随机抽取200例正常颈椎侧位X线片进行R-J线的测量,作为正常对照组。结果所有的患者均获得随访,术后3个月与术前相比两组患者的VAS评分显著降低,差异有统计学意义(P<0.05);两组间的VAS评分比较差异无统计学意义(P>0.05);术后Frankel分级两组患者均恢复到E级;术后6个月两组患者颈椎活动度均接近正常,组间对比差异无统计学意义(P>0.05);术后6个月A、B两组患者骨折均达到骨性愈合,内固定无断裂、脱落;术后两组的R-J线测量均提示枕-寰-枢复合体高度恢复,术后与术前对比差异有统计学意义(P<0.05),组间对比差异无统计学意义(P>0.05)。A组的手术出血量明显较B组少,差异有统计学意义(P<0.05);两组的手术时间基本相同,差异无统计学意义(P>0.05)。结论经口咽及后路单节段内固定治疗Jefferson骨折均取得良好的临床疗效,通过重建寰椎环恢复寰椎的稳定性,利用R-J线的测量间接验证了枕-寰-枢复合体的高度的恢复,同时又最大限度地保留了枕-寰-枢关节的功能,使患者术后的颈椎活动度接近正常,大大提高了患者的生活质量,但两种手术方式的适应证及手术风险有一定的差异,在临床上根据病情评估进行选择。Objective To analyze and compare the clinical effects of transoral mini plate and posterior nail plate single segment fixation in the treatment of Jefferson fractures. Methods A retrospective analysis was carried out on 36 patients diagnosed with unstable Jefferson fractures from April 2012 to October 2016. All patients were divided into 2 groups according to the different operation approaches： Group A（ n = 16）, reduction and fracture fixation by transoral single segment mini plate; Group B（ n = 20）, single segment nail plate fixation. The R-J distance（ the vertical distance from the atlas to the midpoint of the lower edge of the vertebral body base line）, VAS pain score, blood loss, operation time, complication, Frankel classification, postoperative cervical activity were compared and analyzed. 200 cases were randomly selected to measure the R-J line as the control group. Results All patients were followed up. The VAS decreased 3 months postoperatively with significant differences（ P 〈0.05）, while no significant differences between the 2 groups（ P 〉0.05）. The Frankel grade of the 2 groups returned to grade E. Six months after surgery： cervical spine ROM was almost normal with no significant differences between the 2 groups（ P 〉0.05）; bone union was achieved; no internal fixation break or loosening was observed. The R-J line showed the occipital-atlantoaxial complex recovery with significant differences before and after the surgery（ P 〈0.05）, while no significant differences between the 2 groups（ P〉 0.05）. The blood loss in Group A was significantly less than that in Group B with significant differences（ P 〈0.05）. The operation time was similar in the 2 groups with no significant differences（ P 〉0.05）. Conclusions Effects of transoral mini plate and posterior nail plate single segment fixation are good in the treatment of Jefferson fractures. Both restore the stability of the atlas, the height of occipital-atlanto-axial complex, recover the functions, and

关 键 词：脊柱骨折 颈寰椎 骨折固定术 内 

分 类 号：R683.2[医药卫生—骨科学]