后路单椎体内固定治疗寰椎不稳定性骨折  

Posterior single vertebral internal fixation for the treatment of unstable fractures of the atlas

作　　者：普有登[1] 段洪[1] 周兆文[1] 杨俊宇 金雄[1] 尹劲[1] 张涵[1] 蓝天[1] Pu Youdeng;Duan Hong;Zhou Zhaowen;Yang Junyu;Jin Xiong;Yin Jing;Zhang Han;Lan Tian(Department of Orthopedics,The First People's Calmette Hospital of Kunming,Kunming Yunnan,650000,China)

机构地区：[1]昆明市第一人民医院甘美医院骨科,云南昆明650000

出　　处：《生物骨科材料与临床研究》2020年第6期28-31,36,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的观察后路椎弓根螺钉治疗寰椎不稳定性骨折的临床疗效。方法对2011年6月~2016年8月收治的16例寰椎不稳定性骨折患者的资料进行回顾性分析。其中,男10例,女6例;年龄22~46岁,平均(32.9±6.7)岁。患者均存在枕颈部疼痛、活动受限症状,均无脊髓损伤症状。骨折类型:Gehweiler分型Ⅲa型5例、Ⅲb型7例、Ⅳ型4例;Ⅲa型合并下颈椎损伤1例、Ⅲb型合并下颈椎损伤1例;Ⅲb型7例中,横韧带损伤Dickman分型Ⅱa型3例、Ⅱb型4例;Ⅳ型4例中,横韧带损伤Dickman分型Ⅱa型1例、Ⅱb型3例。术前均行颅骨牵引制动稳定骨折块,术前CT测量寰齿前间距(ADI)、记录枕颈部疼痛视觉模拟(VAS)评分,排除手术禁忌证后均行后路单椎体内固定治疗,记录手术时间、术中失血量及并发症情况,末次随访时复查CT寰齿前间距(ADI)、枕颈部VAS评分、颈椎活动范围(ROM),术后影像学检查评估骨折愈合情况。结果 16例患者均完成置钉操作;手术时间为60~90 min,平均(75.9±9.8)min;术中出血量为100~300 m L,平均(180±50.2)m L;未发生脊髓和椎动脉损伤。术后X线片及CT示2例单侧螺钉偏内致椎弓根内侧皮质破裂,但均无血管、神经损伤症状;其余螺钉位置良好。术后随访12~36个月,平均(21.1±6.1)个月。术前枕颈部VAS评分4~7分,平均(5.5±1.2)分;末次随访时枕颈部疼痛VAS评分0~3分,平均(1.3±0.9)分,与术前比较差异有统计学意义(P<0.05)。术前ADI值2.9~5.2mm,平均(4.2±0.7)mm,末次随访ADI值2.0~3.6mm,平均(2.8±0.5)mm,与术前比较差异有统计学意义(P<0.05)。末次随访颈部活动范围(ROM)前屈30°~42°,平均(35.12±3.8)°;后伸29°~38°,平均(33.3±2.8)°;左侧屈31°~46°,平均(37.8±4.0)°;右侧屈33°~48°,平均(38.9±4.8)°;左旋转47°~61°,平均(54.8±4.3)°;右旋转46°~60°,平均(53.3±4.3)°。术后6~9个月,平均(7±0.9)个月复查骨折断端达到骨性愈合,随访期间颈椎序列良好。未见内固定松动�Objective To observe the clinical efficacy of posterior pedicle screw for the treatment of unstable fractures of the atlas. Methods Retrospective analysis was conducted on the case data of 16 patients with atlas unstable fracture from June 2011 to August 2016. Among them, 10 cases were males and 6 cases were females;aged from 22 to 46 years old,with an average of(32.9±6.7) years old. All patients had symptoms of occipital neck pain and restricted mobility, and no spinal cord injury. Fracture types: Gehweiler classification: 5 cases of type Ⅲa, 7 cases of type Ⅲb, 4 cases of type Ⅳ;type Ⅲa with lower cervical spine injury in 1 case, type Ⅲb with lower cervical spine injury in 1 case. Among the 7 cases of type Ⅲb, Dickman classified 3 cases of type Ⅱa and 4 cases of type Ⅱb with transverse ligament injury.Among the 4 patients with type Ⅳ, Dickman classified type IIa and type Ⅱb in 1 and 3 patients with transverse ligament injury. Skull traction were performed before the operation to stabilize the fractures. The atlantodens interval(ADI) and the visual analogue score(VAS) of the occipital and neck pain were measured by CT before the operation. After excluding the contraindications of surgery, all patients were treated with posterior single vertebral internal fixation, recording operation time, intraoperative blood loss and complication, and selecting ADI, pillow neck pain VAS, range of motion(ROM) at the last follow-up, postoperative imaging examination to evaluate fracture healing. Results All16 patients were completed the screw placement operation;the operation time was 60-90 min, with an average of(75.9±9.8) min;intraoperative blood loss was 100-300 m L, with an average of(180±50.2) m L;no spinal cord and vertebral artery injury occurred. Postoperative Xray film and CT showed that 2 cases of unilateral screw internalization caused rupture of the medial cortex of the pedicle,but there were no symptoms of vascular and nerve injury;the other screws were in good positions. The postoperative fol

关 键 词：寰椎骨折 骨折内固定 功能保留 

分 类 号：R683.2[医药卫生—骨科学]