后路内固定非融合治疗上颈椎损伤的疗效  

Injury to upper cervical spine treated by posterior internal fixation without bone graft fusion

作　　者：计中青 周晓中[1] 沈忆新[1] Ji Zhongqing;Zhou Xiaozhong;Shen Yixin(Department of Orthopedics, The Second Affiliated Hospital to Soochow University, Suzhou 215000, China;Department of Orthopaedics, Suzhou Yongding Hospital, Shzhou 215200, China)

机构地区：[1]苏州大学附属第二医院骨科,215000 [2]苏州永鼎医院骨科,215200

出　　处：《中华创伤骨科杂志》2019年第7期618-622,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨后路内固定非融合治疗上颈椎损伤的疗效。方法回顾性分析苏州大学附属第二医院骨科自2010年6月至2017年8月采用后路内固定非融合治疗的35例上颈椎损伤患者的临床资料,其中男21例,女14例;年龄26~56岁,平均44.1岁。所有手术均采用后路枕颈内固定或寰枢椎椎弓根螺钉内固定,不进行植骨融合,待术后随访复查示骨性愈合后,二期手术取出内固定。术后通过日本骨科协会评分(JOA)、疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI),以及颈部僵硬度评价患者术后颈椎恢复情况,通过功能位CT扫描测量C1~C2活动度以评估患者上颈椎旋转功能。结果35例患者均成功置入椎弓根螺钉,术中复位满意,均未发生椎动脉及脊髓损伤。所有患者术后均获随访,时间7~28个月(平均18.1个月)。术前、内固定置入后、末次随访时JOA评分分别为(6.5±1.4)、(7.7±1.5)、(16.1±0.8)分;术前、内固定置入后、末次随访时VAS评分分别为(6.1±1.6)、(2.8±0.8)、(1.1±0.9)分;术前、内固定置入后、末次随访时NDI评分分别为(37.9±2.6)、(20.3±3.8)、(3.7±1.7)分,各项评分内固定置入后较术前有改善,内固定取出后较内固定置入后有改善,差异均有统计学意义(P<0.05)。35例患者中无严重僵硬发生,轻微僵硬12例,无僵硬23例。术后影像学资料示骨折复位良好,均获得骨性愈合。内固定取出后6~12个月颈椎旋转功能明显恢复,功能位CT示C1~C2活动度为(35.4°±2.6°)。结论对于新发的中青年上颈椎损伤采用一期后路枕颈内固定及寰枢椎椎弓根螺钉内固定,不植骨融合,二期取出内固定的手术方式,可以在保证骨性愈合、减轻患者疼痛的同时,最大程度地保留寰枢椎旋转功能,获得满意的临床疗效。Objective To investigate the clinical efficacy of treating injury to the upper cervical spine with posterior internal fixation without bone graft fusion. Methods Included in this retrospective study were 35 patients with upper cervical injury who had been treated at Department of Orthopedics, The Second Affiliated Hospital to Soochow University from June 2010 to August 2017. They were 21 males and 14 females with an average age of 44.1 years (from 26 to 56 years). They were all treated firstly by posterior occipitocervical internal fixation or internal fixation with atlantoaxial pedicle screws without bone graft fusion. The internal fixation was then removed after a solid bone union was confirmed by X-ray. The scores of Japanese Orthopedic Association (JOA), visual analogue scale (VAS), Neck disability index (NDI) and neck stiffness were used to evaluate the functional recovery of the upper cervical spine. We also observed the rotational range of the upper cervical spine using functional CT scan of C1-C2. Results All the pedicle screws were successfully implanted after satisfactory intraoperative reduction, leading to no injury to the vertebral artery or spinal cord. All patients were followed up for an average of 18.1 months (from 7 to 28 months). At preoperation, post-implantation and final follow-up, the JOA scores were 6.5±1.4, 7.7±1.5 and 16.1±0.8 points, the VAS scores 6.1±1.6, 2.8±0.8 and 1.1±0.9 points, and the NDI scores 37.9±2.6, 20.3±3.8 and 3.7±1.7 points, showing significant improvements after internal fixation and after removal of internal fixation (P<0.05). Serious neck stiffness was observed in none of the 35 patients, mild neck stiffness in 12 patients and freedom from neck stiffness in 23 patients. The postoperative radiological analysis revealed fine fracture reduction and bony union in all. After 6 to 12 months the rotation of upper cervical spine was obviously improved and the left-to-right range of rotation of C1-C2 was 35.4°±2.6° as revealed by functional CT scan. Conclusion For

关 键 词：颈椎 创伤和损伤 骨钉 后路内固定 非融合 

分 类 号：R687.3[医药卫生—骨科学]