两种内固定方式治疗不稳定寰椎骨折的疗效比较  

Clinical comparison of two kinds of internal fixation in treatment of unstable atlas fractures

作　　者：张引 金根洋 张帅[1] 李新武 姚建 武鹏 阮汉江 刘锦 ZHANG Yin;JIN Gen-yang;ZHANG Shuai;LI Xin-wu;YAO Jian;WU Peng;RUAN Han-jiang;LIU Jin(Department of Orthopedics,Wuxi Clinical College of Anhui Medical University(904 Hospital of PLA Joint Logistic Support Force),Wuxi,Jiangsu 214044,China)

机构地区：[1]安徽医科大学无锡临床学院(中国人民解放军联勤保障部队第904医院)骨科,江苏无锡214044

出　　处：《中国骨与关节损伤杂志》2021年第11期1121-1124,共4页Chinese Journal of Bone and Joint Injury

基　　金：2015年全军医药卫生科研基金(15ZD005)。

摘　　要：目的比较单节段寰椎椎弓根钉内固定与寰枢椎侧块螺钉内固定治疗不稳定寰椎骨折的临床疗效。方法回顾性分析自2014-01—2019-01诊治的24例不稳定寰椎骨折,14例采用单节段寰椎椎弓根钉内固定治疗(单节段组),10例采用寰枢椎侧块螺钉内固定治疗(多节段组)。比较2组手术时间、术中出血量、住院时间以及末次随访时的疼痛VAS评分、JOA评分、LMD值、R-J线长度、ADI值。结果2组均顺利完成手术并获得完整随访,随访时间10~15个月,平均12.6个月。切口均一期愈合,末次随访时骨折均愈合,寰枢关节功能恢复良好。单节段组手术时间、术中出血量、住院时间均少于多节段组,差异有统计学意义(P<0.05)。末次随访时2组疼痛VAS评分、JOA评分、LMD值、R-J线长度、ADI值比较差异无统计学意义(P>0.05)。结论单节段寰椎椎弓根固定和寰枢椎侧块螺钉固定治疗不稳定寰椎骨折在一定条件下可以取得同样的疗效,对于不同的寰椎骨折,应该具体问题具体分析,慎重地选择合适的手术方式。Objective To compare clinical efficacy between single-segment atlas pedicle screw and atlantoaxial lateral block screw fixation in the treatment of unstable atlantoaxial fractures.Methods Retrospective analysis of 24 cases of unstable atlas fractures treated from January 2014 to January 2019 was conducted.Fourteen cases were treated with single-segment atlas pedicle screw internal fixation(single-segment group)and 10 cases with atlantoaxial lateral block screw internal fixation(multi-segment group).The operative time,intraoperative bleeding,length of hospital stay,and pain VAS score,JOA score,LMD value,RJ line length,and ADI value at the last follow-up were compared between the 2 groups.Results Both groups successfully completed the operation and obtained a complete follow-up.The follow-up time was 10-15 months,with an average of 12.6 months.All incisions healed in one stage,and all fractures healed at the last follow-up,with good functional recovery of the atlantoaxial joint.The operative time,intraoperative bleeding,and hospital stay in the single-segment group were less than those in the multi-segment group,and the difference was statistically significant(P<0.05).The differences in pain VAS score,JOA score,LMD value,R-J line length,and ADI value between the 2 groups at the final follow-up were not statistically significant(P>0.05).ConclusionSingle-segment fixation of the atlas pedicle and lateral block screw fixation of atlantoaxial for unstable atlas fractures can achieve the same efficacy under certain conditions.For different atlas fractures,specific problems should be analyzed and the appropriate surgical method should be carefully chosen.

关 键 词：寰椎骨折 单节段寰椎椎弓根固定 寰枢椎侧块螺钉固定 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]