不稳定性寰椎骨折手术与非手术治疗效果对比  

Comparison of Surgical and Non-surgical Treatment for Unstable Atlas Fractures

作　　者：张帅[1] 张引 李新武 武鹏 姚建 金根洋 ZHANG Shuai;ZHANG Yin;LI Xin-wu;WU Peng;YAO Jian;JIN Gen-yang(Department of Orthopedics,Wuxi Clinical College of Anhui Medical University,Wuxi 214044,Jiangsu,China;Department of Orthopedics,904 Hospital of Joint Logistics Support Force of PLA,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]解放军联勤保障部队第九〇四医院骨科,江苏无锡214044

出　　处：《医学信息》2022年第4期92-97,共6页Journal of Medical Information

基　　金：全军医药卫生科研基金项目(编号:15ZD005)。

摘　　要：目的比较C1椎弓根螺钉+"Ω"形横连内固定术和非手术治疗不稳定性寰椎骨折的效果。方法选取2012年6月-2020年10月我院收治的24例不稳定性寰椎骨折患者作为研究对象,根据治疗方式不同分为A组(n=13)和B组(n=11)。A组予以非手术方式治疗,B组予以C1椎弓根螺钉+"Ω"形横连内固定术治疗,比较两组治疗后一般情况(住院时间、骨折愈合时间、恢复日常生活时间及治疗期间并发症发生)、寰椎侧块移位距离(LMD)、枢椎椎体下缘中点到基底线垂直距离(R-J距离)、颈椎疼痛视觉模拟(VAS)评分和颈椎功能障碍指数(NDI)。结果 B组住院时间、骨折愈合时间、恢复日常生活时间、并发症发生情况均优于A组,差异有统计学意义(P<0.05);影像学检查示,B组骨折愈合良好,未出现畸形愈合、延迟愈合及不愈合,未见内植物移位、断裂等情况发生;而A组有3例在非手术治疗去除外固定支具后,发现骨折移位、骨折未愈合;两组随访12个月时LMD、R-J距离均治疗前改善,且B组优于A组,差异有统计学意义(P<0.05);两组随访12个月时VAS评分、NDI评分较治疗前改善,且B组优于A组,差异有统计学意义(P<0.05)。结论相较于非手术治疗,C1椎弓根螺钉+"Ω"形横连内固定术治疗不稳定性寰椎骨折的效果良好,该手术方式能解剖复位骨折断端,骨折愈合率高,可最大程度保留颈椎活动度,同时住院时间短,恢复日常生活时间快。Objective To compare the clinical efficacy of C1 pedicle screw+"Ω"transverse internal fixation and non-surgical treatment of unstable atlas fractures.Methods Twenty-four patients with unstable atlas fractures admitted to our hospital from June 2012 to October 2020 were selected and divided into group A(n=13)and group B(n=11)according to different treatment methods.Group A was treated with non-surgical treatment,and group B was treated with C1 pedicle screw+"Ω"transverse internal fixation.The general conditions(hospitalization time,fracture healing time,recovery of daily life time and complications during treatment),the displacement distance of atlas lateral mass(LMD),the vertical distance from the midpoint of the lower edge of the axial vertebral body to the basal line(R-J distance),the visual analogue scale(VAS)score of cervical pain and the cervical dysfunction index(NDI)were compared between the two groups after treatment.Results The hospitalization time,fracture healing time,recovery time of daily life and complications in group B were better than those in group A,and the difference was statistically significant(P<0.05).Imaging examination showed that fracture healing was good in group B,and there was no malunion,delayed healing and nonunion,and no internal plant displacement and fracture occurred;while in group A,3 cases were found fracture displacement and nonunion after non-surgical treatment.After 12 months of follow-up,the LMD and R-J distance of the two groups were improved before treatment,and the group B was better than the group A,the difference was statistically significant(P<0.05).The VAS score and NDI score of the two groups were improved after 12 months of follow-up,and those in group B were better than those in group A,the difference was statistically significant(P<0.05).Conclusion Compared with non-surgical treatment,C1 pedicle screw+"Ω"transverse internal fixation has a good effect in the treatment of unstable atlas fractures.This surgical method can anatomically reset the fracture ends,wit

关 键 词：寰椎骨折 “Ω”形横连内固定术 单节段固定 

分 类 号：R683.2[医药卫生—骨科学]