寰椎椎弓根钉横向加压技术治疗Jefferson-3型寰椎骨折  

Effect of pedicle screw transverse compression technique in the treatment of Jefferson-3 atlas fractures

作　　者：张引 金跟洋 姚建 李新武 张帅[1] 武鹏 阮汉江 刘锦 庞永华 ZHANG Yin;JIN Gen-yang;YAO Jian;LI Xin-wu;ZHANG Shuai;WU Peng;RUAN Han-jiang;LIU Jin;PANG Yong-hua(Department of Orthopaedics,Wuxi Clinical College,Anhui Medical University,Wuxi 214044,Jiangsu,CHINA;Department of Orthopaedics,904 Hospital of the Joint Service Support Force of the Chinese People's Liberation Army,Wuxi 214044,Jiangsu,CHINA)

机构地区：[1]安徽医科大学无锡临床学院骨科,江苏无锡214044 [2]中国人民解放军联勤保障部队第九○四医院骨科,江苏无锡214044

出　　处：《海南医学》2022年第1期31-35,共5页Hainan Medical Journal

基　　金：江苏省南京军区重大研究专项项目(编号:15ZD005)。

摘　　要：目的验证寰椎后路单节段椎弓根螺钉横向加压技术治疗Jefferson-3型寰椎骨折的有效性和优越性。方法回顾性分析2015年1月至2018年12月在中国人民解放军联勤保障部队第九〇四医院骨科行寰椎椎弓根螺钉加横连手术治疗的24例不稳定寰椎骨折患者的临床资料。记录患者的手术时间、出血量、住院时间、并发症以及随访时间,比较术前和末次随访时的疼痛视觉模拟评分量表(VAS)评分、颈椎功能障碍指数(NDI)、寰椎侧块移位(LMD)、枢椎锥体下缘中点到基底线垂直距离(R-J线)、寰齿间距(ADI)及骨折愈合情况。结果手术进行顺利,所有患者均恢复良好,一期出院;患者平均手术时间(77.79±5.08) min,平均出血量(163.96±23.64) mL,平均住院时间(18.50±1.53) d,平均随访时间(13.5±1.32)个月;末次随访时,寰椎VAS评分、NDI评分、LMD、R-J线以及ADI较术前有明显改善,差异均具有统计学意义(P<0.05);住院期间所有患者均无伤口、全身、肺部以及泌尿系感染等症状,无血栓、压疮、尿储留等并发症,切口愈合良好;随访过程中无内固定松动、断裂等并发症;经过手术治疗骨折得到稳定固定且寰枢关节稳定性恢复,末次随访时见寰椎后弓骨折已愈合,患者颈椎功能恢复良好,疼痛消失,上颈椎活动恢复正常,无神经功能缺陷症状。结论寰椎后路单节段椎弓根螺钉横向加压治疗Jefferson-3型寰椎骨折效果肯定,且具有独特优越性。Objective To verify the effectiveness and superiority of the posterior atlas single-segment pedicle screw transverse compression technique in the treatment of Jefferson-3 atlas fractures. Methods The clinical data of24 patients of unstable atlas fractures treated by atlas single-segment pedicle screw transverse compression technique at the Department of Orthopaedics, 904 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army from January 2015 to December 2018 were retrospectively analyzed. The operative time, bleeding volume, length of hospital stay, complications, and follow-up time were recorded, and Visual Analog Scale(VAS) score before operation and at final follow-up, cervical dysfunction index(NDI), atlantoaxial lateral mass displacement(LMD), vertical distance from the midpoint of the inferior edge of the pivot cone to the baseline(R-J line), atlantoaxial distance(ADI),and fracture healing were compared between the two groups. Results The surgery was performed successfully. All patients recovered well and were discharged in one stage, with a mean operative time of(77.79 ± 5.08) min, a mean bleeding volume of(163.96±23.64) mL, a mean length of stay of(18.50±1.53) days, and a mean follow-up of(13.5±1.32) months. At the final follow-up, atlantoaxial VAS score, NDI score, LMD, R-J line, and ADI were significantly improved compared to those before operation, with statistically significant differences(P<0.05). There were no wound,systemic, pulmonary, or urinary tract infections during hospitalization, and there were also no complications such as blood clots, pressure sores, or urinary retention. The incision healed well. There were no complications such as loosening and breaking of the internal fixation during the follow-up period. After surgical treatment, the fracture was stabilized and the stability of the atlantoaxial joint was restored. At the time of the last follow-up, the posterior atlantoaxial arch fracture had healed, and the patients had good recovery of cervical fun

关 键 词：寰椎骨折 单节段固定 椎弓根螺钉 横向加压 生理性固定 

分 类 号：R683[医药卫生—骨科学]