后路单节段椎弓根钉内固定治疗不稳定寰椎骨折  

Posterior single-segment pedicle screw fixation for unstable atlas fractures

作　　者：鲍凯 宋文慧[1] 刘昌文[1] 梁凯恒[1] 王佳佳 Bao Kai;Song Wenhui;Liu Changwen;Liang Kaiheng;Wang Jiajia(Department of Orthopedics,Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2023年第4期594-599,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:近几十年来不稳定寰椎骨折的治疗一直存有争议,手术方式的选择也已从C_(1)-C_(2)或C_(0)-C_(2)融合发展到现在尽可能保留运动节段,然而,无论是经口入路还是后路入路,复位效果及术后并发症问题仍待进一步研究。目的:观察后路单节段椎弓根钉内固定治疗不稳定寰椎骨折的疗效。方法:回顾性分析2017年7月至2020年9月山西医科大学第二医院收治的14例不稳定寰椎骨折患者的临床资料,男10例,女4例,平均年龄51.8岁,所有患者均采用单节段椎弓根螺钉-棒系统进行后路切开复位内固定治疗。查阅病历和术前、术后X射线片,并通过术前和术后CT扫描,根据Spence标准即张口位X射线片寰椎两侧块移位之和≥6.9 mm判定为不稳定寰椎骨折,同时明确骨折类型,并评估骨折复位情况,末次随访时行颈椎过伸过屈位X射线片来评估寰枢关节是否稳定。结果与结论:①14例患者均成功完成手术,平均随访(21.0±6.4)个月,术后复查颈椎X射线片及CT均可见内固定位置良好,复位良好;所有患者均未出现神经功能受损、椎动脉损伤、伤口感染等与手术相关的并发症;②目测类比评分由术前的(6.5±1.3)分降至术后的(1.9±0.8)分,差异有显著性意义(P<0.05);颈部功能障碍指数由术前的74.4±4.5降至末次随访时的12.1±4.3,差异有显著性意义(P<0.05);③末次随访时颈部屈伸70°-88°(79.7±6.0)°;颈部左右侧屈76°-85°(82.1±2.8)°;左右旋转129°-155°(143.5±8.4),所有患者在末次随访时颈椎活动范围均恢复良好,末次随访时拍摄颈椎过伸过屈位X射线片未见寰枢关节存在任何不稳定的影响学表现;术后4例患者主诉颈部僵硬伴活动受限,在规范康复及指导治疗下均基本恢复正常水平;④提示后路单节段椎弓根钉内固定治疗不稳定寰椎骨折手术时间短、出血量少、并发症少,复位效果也较好,而且更主要的是患者颈部屈伸及旋转功BACKGROUND:In recent decades,the treatment of unstable atlantogenic fractures has been controversial,and the choice of surgical methods has evolved from C_(1)-C_(2) or C_(0)-C_(2) fusion to the present situation of preserving motor segments as much as possible.However,the reduction effect and postoperative complications of both oral and posterior approaches remain to be improved.OBJECTIVE:To observe the effect of posterior single-segment pedicle screw fixation on unstable atlas fractures.METHODS:Clinical data of 14 patients with unstable atlas fractures admitted from July 2017 to September 2020 in Second Hospital of Shanxi Medical University were retrospectively analyzed.There were 10 males and 4 females,with an average age of 51.8 years.All patients underwent posterior open reduction and internal fixation using a single-segment pedicle screw-rod system.Medical records and preoperative and postoperative radiographs were reviewed,and preoperative and postoperative CT scans were used to determine fracture types and assess fracture reduction.According to Spence's standard,the sum of displacement on both sides of the atlas in the mouth-opening X-ray film≥6.9 mm was judged as unstable atlas fractures.At the last follow-up,cervical hyperextension and hyperflexion X-ray films were used to assess the stability of the atlantoaxial joint.RESULTS AND CONCLUSION:(1)All 14 patients were successfully operated.The mean follow-up duration was(21.0±6.4)months.Postoperative cervical X-ray and CT examination showed that the internal fixation position was good and the reduction was good.None of the patients had neurological impairment,vertebral artery injury,wound infection or other surgery-related complications.(2)Visual analogue scale score significantly decreased from(6.5±1.3)before operation to(1.9±0.8)after operation(P<0.05).Neck Disabilitv Index score significantly decreased from(74.4±4.5)before surgery to(12.1±4.3)at the last follow-up(P<0.05).(3)At the last follow-up,cervical flexion and extension ranged from 70°to 8

关 键 词：寰椎骨折 颈后路 单节段 内固定 椎弓根钉 骨折复位 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687