O型臂导航在强直性脊柱炎合并下颈椎骨折治疗中的应用  

O-arm navigation assisted treatment in ankylosing spondylitis combined with fracture of subaxial cervical spine

作　　者：俞仲翔[1] 王树强[1] 史萌[1] 邹翰林 YU Zhong-xiang;WANG Shu-qiang;SHI Meng;ZOU Han-lin(Department of Orthopedics,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China;Department of Orthopedics,Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200033,China)

机构地区：[1]上海市中医药大学附属曙光医院骨科,上海200021 [2]上海市中医药大学附属普陀医院骨科,上海200033

出　　处：《局解手术学杂志》2019年第10期798-802,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：上海中医药大学预算内项目(18LK038,2016YSN45)

摘　　要：目的探讨O型臂导航辅助治疗强直性脊柱炎(AS)合并下颈椎骨折临床疗效。方法选择2009年1月至2014年12月强直性脊柱炎合并下颈椎骨折手术治疗的患者26例,按照手术方法不同分为A、B组。其中徒手置钉方法治疗患者15例为A组,采用O型臂导航辅助手术治疗患者11例为B组。记录2组患者手术时间、术中出血量、并发症等围手术期情况;比较术后1周骨折部位疼痛VAS及末次随访时神经功能损伤恢复情况(Frankel分级)。结果 26例手术患者中,除A组1例患者住院期间死亡,其余患者随访12~86个月,至末次随访时骨折部位均骨性愈合,随访过程中无骨折不愈合、假关节形成、内固定失效等情况。B组术中出血量(72±20. 8) m L、手术时间(126. 7±16. 5) min低于A组的(97. 4±16. 3) m L、(168. 2±10. 8) min,差异具有统计学意义(P <0. 05)。所有患者症状均在随访过程中逐步改善。2组患者术后神经功能损伤恢复程度及骨折部位疼痛缓解程度均较术前显著改善,差异有统计学意义(P <0. 05),但2组间比较差异无统计学意义(P> 0. 05)。B组术中无血管、神经损伤等严重并发症发生,2例术后出现肺炎,予以加强抗感染、促进排痰、翻身拍背后等处理痊愈。A组2例出现术中硬膜囊破裂、脑脊液漏,经腰大池引流、换药、伤口加压后愈合;3例术后出现肺部感染,1例因肺部感染死亡。结论 AS合并颈椎骨折患者病情复杂,治疗棘手,保守治疗效果不佳。O型臂导航辅助手术提高了置钉的精确性,较传统徒手置钉手术可显著缩短手术时间、降低术中出血量,临床意义显著。Objective To explore the clinical effect of O-arm navigation assisted treatment in ankylosing spondylitis ( AS) combined with fracture of subaxial cervical spine. Methods Totally 26 cases of ankylosing spondylitis complicated with subaxial cervical spine fractures who were admitted into our hospital from January 2009 to December 2014 were studied retrospectively. The patients were divided into group A and group B according to different surgical methods. Among them,15 patients ( group A) were treated with free-hand nail placement, while the other 11 patients ( group B) received O-arm navigation operation. The operative time,intraoperative blood loss and complications of patients in the two groups were recorded to evaluate the perioperative situation. Clinical efficacy was evaluated by comparing VAS score at 1 week after surgery and recovery of nerve function ( Frankel scale) at the last follow-up. Results Except one death case ( group A) in hospital,the other 25 patients were followed up for 12 to 86 months. All the 25 patients got solid bone fusion at the final follow-up,and there was no fracture nonunion,false joint formation or failure of internal fixation during the follow-up. The mean operation time and blood loss of group B were significantly less than those in group A [( 126. 7 ±16. 5) min vs.( 168. 2 ±10. 8) min;( 72 ±20. 8) mL vs.( 97. 4 ±16. 3) mL],and the difference was statistically significant ( P <0. 05). The degree of postoperative nerve function recovery and pain relief in the two groups were significantly improved compared with that before surgery,with statistically significant difference ( P <0. 05),but the difference between the two groups was not statistically significant ( P >0. 05). In group B,there was no intraoperative complication such as vascular and nerve injury;2 cases of pneumonia was found after operation,and they were cured with anti-infection,sputum excretion and back patting. In group A, 2 patients had intraoperative dural sac rupture and cerebrospinal fluid leakage,which heale

关 键 词：强直性脊柱炎 下颈椎骨折 O型臂导航 徒手置钉 

分 类 号：R683.2[医药卫生—骨科学]