寰椎后弓环抱钩与枢椎椎弓根螺钉内固定治疗寰枢椎不稳的疗效研究  

Therapeutic effect study of atlas posterior arch hooks and the dentata pedicle screw internal fixation for atlantoaxial instability

作　　者：杨金华 黄开 潘文明 张伟[1] 沈忆新[2] YAGNG Jin-hua;HUANG Kai;PAN Wen-ming;ZHANG Wei;SHEN Yi-xin(Department of Spinal Surgery,The Second People's Hospital of Changshu,The Fifth Clinical Medical College of Yangzhou University,Changshu 215000,Jiangsu;Spinal Surgery,The Second People's Hospital affiliated to Soochow University,Suzhou 215004,China)

机构地区：[1]扬州大学第五临床医学院常熟市第二人民医院脊柱外科,江苏常熟215000 [2]苏州大学附属第二人民医院脊柱外科,江苏苏州215004

出　　处：《颈腰痛杂志》2020年第4期426-428,共3页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨寰椎后弓环抱钩与枢椎椎弓根螺钉内固定治疗寰枢椎不稳的临床疗效。方法纳入2004年12月~2018年12月于本院治疗的20例寰枢椎不稳患者,均采用寰椎后弓环抱钩与枢椎椎弓根螺钉内固定治疗,随访24个月以上。记录患者手术完成情况及相关指标,比较术前、术后3个月、末次随访的VAS评分、JOA评分,记录术前、末次随访的ASIA脊髓损伤分级,记录并发症发生情况。结果手术平均耗时(121.76±18.65)min,出血量(204.55±25.41)mL,引流量(241.22±21.09)mL,住院时间(12.87±2.87)d;术后3个月、末次随访的VAS评分显著降低,JOA评分显著升高,较术前的差异均有统计学意义(P<0.05);末次随访ASIA分级较术前显著改善,差异有统计学意义(P<0.05);术后所有患者均植骨融合,发生1例切口感染、1例肩颈疼痛,无继发神经损伤、内固定脱落、断裂等严重并发症。结论寰椎后弓环抱钩与枢椎椎弓根螺钉内固定治疗寰枢椎不稳,内固定稳固、植骨融合率高,可降低后路手术医源性神经、血管损伤的风险。Objective To study the clinical effect of atlas posterior arch hooks and the dentata pedicle screw internal fixation for atlantoaxial instability.Methods Twenty patients with atlantoaxial instability who were treated in our hospital from December 2004 to December 2018 were selected as the study subjects.All patients were treated with atlas posterior arch hooks and dentata pedicle screw internal fixation treatment.All patients were followed up for more than 24 months.The patient's surgical completion and related indicators were recorded.The preoperative,postoperative 3 months,last follow-up VAS score,JOA score were compared.The preoperative and final follow-up of the American Spinal Injury Association(ASIA)spinal cord injury grading and the occurrence of complications were recorded.Results The average time of surgery(121.76±18.65)min,the amount of bleeding(204.55±25.41)mL,the drainage volume(241.22±21.09)mL,the hospitalization time(12.87±2.87)d.The VAS pain score was significantly decreased at 3 months and the last follow-up,and the JOA score was significantly increased.The difference was statistically significant(P<0.05).The ASIA classification at the last follow-up was significantly improved compared with preoperative,and the difference was statistically significant(P<0.05).All patients underwent bone graft fusion.One case of wound infection after operation,one shoulder and neck pain,no secondary nerve injury,internal fixation shedding,fracture and other serious complications.Conclusion The atlas posterior arch hooks and the dentata pedicle screw internal fixation for the treatment of atlantoaxial instability are stable,and the fusion rate of bone graft is high,which can reduce the risk of iatrogenic nerve and blood vessel injury in posterior surgery.

关 键 词：寰椎后弓环抱钩 枢椎椎弓根螺钉 寰枢椎不稳 

分 类 号：R687.3[医药卫生—骨科学]