线缆内固定融合术治疗创伤性寰枢椎不稳的中远期疗效  

Medium-and long-term efficacy of cable technique in treatment of traumatic atlantoaxial instability

作　　者：陶春生 孙培锋 赵金柱 胡健 刘建东 曲良 倪斌 Tao Chunsheng;Sun Peifeng;Zhao Jinzhu;Hu Jian;Liu Jiandong;Qu Liang;Ni Bin(Department of Orthopaedics,Navy No.971 Hospital of Chinese PLA,Qingdao 266071,Shandong,China;Department of Orthopaedics,Changzheng Hospital,Navy Medical University,Shanghai 200003,China)

机构地区：[1]中国人民解放军海军第九七一医院骨科,青岛266071 [2]海军军医大学长征医院骨科,上海200003

出　　处：《脊柱外科杂志》2021年第4期239-242,共4页Journal of Spinal Surgery

摘　　要：目的探讨线缆内固定融合术治疗创伤性寰枢椎不稳的中远期疗效。方法 2004年7月-2015年7月,22例创伤性寰枢椎不稳患者在中国人民解放军海军第九七一医院和海军军医大学长征医院接受后路线缆内固定融合术治疗及随访,其中12例采用Gallie术式,10例采用Brooks术式。记录患者术前、术后及末次随访时头颈椎旋转角、下颈椎后凸角、日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分、颈椎功能障碍指数(NDI),评价疗效及预后。结果 22例患者随访5 ~ 16(7.5±2.3)年,20例患者获得了一期骨性融合;Gallie术式、Brooks术式各1例随访2年未融合,改行Magerl螺钉并Brooks融合术,末次随访获得骨性融合。所有患者术后3个月及末次随访JOA评分、VAS评分、NDI与术前相比明显改善,差异均有统计学意义(P < 0.05),末次随访与术后3个月比较差异均无统计学意义(P > 0.05)。末次随访时下颈椎后凸角与术前及术后3个月相比,差异均有统计学意义(P < 0.05)。末次随访时头颈椎旋转角与术后3个月相比差异有统计学意义(P < 0.05)。末次随访时患者头颈部旋转功能平均丢失13.5%,下位颈椎不同程度后凸畸形发生率为63.6%(14/22)。结论线缆内固定融合术治疗创伤性寰枢椎不稳中远期疗效满意;但融合术后头颈部旋转功能少量丢失,远期下位颈椎后凸畸形发生率较高。Objective To investigate the medium-and long-term efficacy of cable technique in the treatment of traumatic atlantoaxial instability.Methods From July 2004 to December 2015,22 cases of traumatic atlantoaxial instability in Navy No.971 Hospital of Chinese PLA and Changzheng Hospital were treated with cable technique and followed up.Among them,12 cases were treated with Gallie operation and 10 with Brooks operation.The rotation angle of head and neck,lower cervical kyphosis angle,Japanese Orthopaedic Association(JOA)score,visual analogue scale(VAS)score and neck disability index(NDI)were recorded before operation,after operation and at the final follow-up to evaluate the efficacy and prognosis.ResultsThe patients were followed up for 5-16(7.5±2.3)years.Among 22 cases,20 cases obtained primary bone fusion,1 with Gallie operation and 1 with Brooks operation were followed up for 2 years without fusion,and changed to Magerl screw and Brooks operation,finally obtained bone fusion.JOA score,VAS score and NDI were significantly improved in all the patients at postoperative 3 months,and the difference was statistically significant(P<0.05),and there was no significant difference between the final follow-up and postoperative 3 months(P>0.05).The lower cervical kyphosis angle at the final follow-up was significantly different from that before operation and at postoperative 3 months(P<0.05).At the final follow-up,the rotation angle of head and neck was significantly different from that at postoperative 3 months(P<0.05).The average loss of head and neck rotation function was 13.5%and the incidence of different degrees of kyphosis in the lower cervical spine was 63.6%(14/22).Conclusions The medium-and long-term efficacy of cable technique in the treatment of traumatic atlantoaxial instability is satisfactory.After fusion,the function of head and neck rotation is slightly lost,and the incidence of lower cervical kyphosis is higher in the long term.

关 键 词：寰椎 枢椎 关节不稳定性 内固定器 

分 类 号：R681.531[医药卫生—骨科学]