后路椎弓根螺钉非融合和融合内固定术治疗齿状突骨折的疗效比较  

Comparison between non-fusion and fusion internal fixation with posterior pedicle screw for odontoid fracture

作　　者：王圣杰 田纪伟[2] 余正红[1] 高坤[1] 邵佳 刘俭涛 吕东波 高延征[1] Wang Shengjie;Tian Jiwei;Yu Zhenghong;Gao Kun;Shao Jia;Liu Jiantao;Lyu Dongbo;Gao Yanzheng(Department of Spine and Spine Cord Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Orthopedics,First Affiliated Hospital of Shanghai Jiaotong University,Shanghai 201620,China)

机构地区：[1]河南省人民医院脊柱脊髓外科,郑州450003 [2]上海交通大学附属第一人民医院骨科,上海201620

出　　处：《中华创伤杂志》2019年第8期723-729,共7页Chinese Journal of Trauma

基　　金：河南省科技攻关项目(162102310018);河南省科技创新杰出人才项目(154200510027).

摘　　要：目的探讨后路椎弓根螺钉非融合和融合内固定术治疗齿状突骨折的疗效.方法采用回顾性病例对照研究分析2013年1月—2015年6月河南省人民医院收治的46例齿状突骨折患者的临床资料,其中男35例,女11例;年龄19~62岁[(36.9±1.6)岁].齿状突骨折Anderson和D'Alonzo分型:ⅡA型5例,ⅡB型8例,ⅡC型22例,浅Ⅲ型6例,未被分型5例.患者术前脊髓功能美国脊髓损伤协会(ASIA)分级均为D级或E级.其中15例行后路椎弓根螺钉非融合内固定术(A组),在术后12~29个月取出椎弓根螺钉60枚;31例行植骨融合内固定术(B组),在术后124枚椎弓根螺钉一直未取出.比较两组随访时间、手术时间、术中透视时间、术中出血量,以及术前、术后1年(均未拆除内固定时)、末次随访时颈背痛视觉模拟评分(VAS)、颈部旋转度数、颈部功能障碍指数(NDI)评分.结果两组随访时间、手术时间、术中透视时间、术中出血量、术前及术后1年VAS、术后1年颈部旋转度数、术前及术后1年NDI评分差异无统计学意义(P>0.05).两组末次随访时VAS、颈部旋转度数、NDI评分中的"开车散步"和"娱乐活动"差异有统计学意义(P<0.05).两组末次随访时NDI评分"颈部不适""个人护理""提起重物""看书/电视""头痛情况""注意力""工作状态""睡眠障碍"差异无统计学意义(P>0.05).结论后路椎弓根螺钉内固定术治疗齿状突骨折具有良好的疗效,后路椎弓根螺钉非融合内固定术较融合内固定术更有利于颈椎旋转功能的恢复、颈背部疼痛的缓解和患者开车散步、娱乐活动方面的改善.Objective To investigate the clinical efficacy of non-fusion and fusion internal fixation with posterior pedicle screw for odontoid fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with odontoid fractures admitted to Henan Provincial People's Hospital from January 2013 to June 2015. There were 35 males and 11 females, aged 19-62 years [(36. 9 ± 1. 6)years]. The preoperative odontoid fractures were classified as type IIA in five patients, type IIB in eight, type IIC in 22, shallow type III in six according to Anderson and D'Alonzo typing. The fractures of five patients were not classified. According to the ASIA grading, the preoperative spinal cord function was graded as D or E in the 46 patients. Among the patients, 15 underwent posterior pedicle screw non-fusion internal fixation ( Group A), with 60 pedicle screws removed 12-29 months after operation. A total of 31 patients were treated with fusion internal fixation with posterior pedicle screw ( Group B), with 124 pedicle screws free from removal after operation. The follow-up time, operation time, intraoperative fluoroscopy time, intraoperative blood loss as well as visual analog scale (VAS), cervical rotation degree, and neck disability index ( NDI) before operation, 1 year after surgery ( when no internal fixation was removed ) and at the last follow-up were compared between the two groups. Results There were no significant differences between the two groups in the follow-up time, operation time, intraoperative fluoroscopy time, intraoperative blood loss, VAS score, neck rotation degree, NDI score before operation and at 1 year after operation (P >0. 05). There were significant differences between two groups in VAS scores, neck rotation degree, NDI scores indicating driving and walking and recreational activities at the last follow-up ( P <0. 05 ). There were no significant differences between two groups in other NDI scores items, including neck discomfort, personal care, lifting heavy objects,

关 键 词：齿突尖 骨折固定术 内 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]