枢椎椎板钉治疗可复性寰枢椎脱位的近期疗效  

Short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation

作　　者：邓轩赓[1] 熊小明[1] 石华刚[1] 万趸[1] 崔伟 宋偲茂[1] 梅国龙[1] 侯伟[1] DENG Xuangeng;XIONG Xiaoming;SHI Huagang;WAN Dun;CUI Wei;SONG Simao;MEI Guolong;HOU Wei(Department of Spine,Sichuan Provincial Orthopedic Hospital,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川省骨科医院脊柱科

出　　处：《中国修复重建外科杂志》2019年第11期1419-1423,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨枢椎椎板钉用于可复性寰枢椎脱位(reducible atlantoaxial dislocation,RAAD)的近期疗效。方法回顾分析2013年2月-2018年2月收治并符合选择标准的41例RAAD患者临床资料。术中寰椎均为侧块螺钉固定,枢椎采用椎板钉固定13例(椎板钉组)、椎弓根钉固定28例(椎弓根钉组)。两组患者性别、年龄及术前日本骨科协会(JOA)评分等一般资料比较,差异均无统计学意义(P>0.05)。术后行JOA评分,影像学检查螺钉植入准确性、植骨融合以及内固定物稳定性。结果术后两组切口均达Ⅰ期愈合。患者均获随访,椎板钉组随访时间12~17月,平均13.8个月;椎弓根钉组12~20个月,平均14.1个月;组间差异无统计学意义(Z=-0.704,P=0.482)。末次随访时,椎板钉组及椎弓根钉组JOA评分分别为(13.9±1.6)、(14.3±1.8)分,较术前明显改善(t=-9.033,P=0.000;t=-15.835,P=0.000),但组间差异无统计学意义(t=-0.630,P=0.532)。椎板钉组共植入26枚螺钉,其中25枚螺钉准确植入;椎弓根钉组共植入56枚螺钉,其中54枚螺钉准确植入;两组螺钉植入准确率差异无统计学意义(Z=-0.061,P=0.951)。椎板钉组均获得寰枢椎后方骨性融合;椎弓根钉组1例后方融合影像不连续,其余患者均获骨性融合;两组融合率比较差异无统计学意义(Z=-0.681,P=0.496)。随访期间两组均无内固定物松动。结论枢椎椎板钉治疗RAAD安全、可靠,能维持寰枢椎初始稳定性,近期疗效较好,可作为椎弓根钉替代方法之一。Objective To investigate reliability and short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation(RAAD). Methods A clinical data of 41 patients with RAAD who were admitted between February 2013 and February 2018 and met the inclusion criteria was retrospectively analyzed. The atlases in all patients were fixated by lateral mass screws, and the axes were fixed by laminar screws in 13 cases(LS group) and by pedicle screws in 28 cases(PS group). There was no significant difference in gender, age, and preoperative Japanese Orthopedic Association(JOA) score between the two groups(P>0.05). The effectiveness was estimated by post-operative JOA score;and the accuracy of the axis screw, atlantoaxial bone graft fusion, and the fixation stability were examined by X-ray film and CT. Results All incisions healed by first intention. All patients were followed up 12-17 months(mean, 13.8 months)in LS group and 12-20 months(mean 14.1 months) in PS group, and the difference in follow-up time was not significant(Z=-0.704, P=0.482). At last follow-up, JOA scores were 13.9±1.6 in LS group and 14.3±1.8 in PS group, which significantly improved when compared with the pre-operative scores in the two groups(t=-9.033, P=0.000;t=-15.835,P=0.000);while no significant difference was found between the two groups(t=-0.630, P=0.532). Twenty-five screws of 26 screws in LS group and 54 screws of 56 screws in PS group were implanted accurately, with no significant difference in the accuracy of the axis screw between the two groups(Z=-0.061, P=0.951). All patients obtained atlantoaxial bone graft fusion, except 1 case in PS group. There was no significant difference in the atlantoaxial bone graft fusion between the two groups(Z=-0.681, P=0.496). Conclusion For RAAD, Axis laminar screws can maintain the atlantoaxial primary stability and had a good short-term effectiveness. So, it could be an alternative and reliable technique for axis screw.

关 键 词：可复性寰枢椎脱位 椎板钉 椎弓根钉 内固定 

分 类 号：R68[医药卫生—骨科学]