JeRP钢板与微型钛板经口咽入路单节段固定治疗不稳定型寰椎骨折的疗效比较  

Comparison of Jefferson-fracture reduction plate and micro titanium plate in the transoral single-segment fixation of unstable atlas fractures

作　　者：涂强 陈虎 孙昊 黄显华 朱昌荣 马向阳 王建华 章凯 尹庆水 夏虹 Tu Qiang;Chen Hu;Sun Hao;Huang Xianhua;Zhu Changrong;Ma Xiangyang;Wang Jianhua;Zhang Kai;Yin Qingshui;XiaHong(Department of Orthopedic Surgery,General Hospital of Southern Theatre Command,Guangzhou 510010,China;The First Clinical Medical College of Southern Medical University,Guangzhou 510010,China;Guangzhou University of Chinese Medicine,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院骨科,广州510010 [2]南方医科大学第一临床医学院,广州510010 [3]广州中医药大学研究生院,广州510010

出　　处：《中华创伤骨科杂志》2022年第11期957-964,共8页Chinese Journal of Orthopaedic Trauma

基　　金：军队医学科技青年培育计划孵化项目(19QNP040);军队后勤科研计划项目(CLB20J033)。

摘　　要：目的比较JeRP钢板与微型钛板经口咽入路单节段固定治疗不稳定型寰椎骨折的疗效。方法回顾性分析2008年1月至2020年12月中国人民解放军南部战区总医院骨科收治的45例不稳定型寰椎骨折患者资料。男24例,女21例;年龄15~67岁;寰椎骨折Gehweiler分型:Ⅰ型11例,Ⅲ型34例;美国脊髓损伤协会(ASIA)脊髓损伤分级:D级7例,E级38例;寰椎横韧带损伤的Dickman分型:Ⅰ型4例,Ⅱ型11例。将所有患者根据治疗方法不同分为2组:JeRP钢板组26例(采用JeRP钢板经口咽入路单节段固定治疗)和微型钛板组19例(采用微型钛板经口咽入路单节段固定治疗)。记录并比较两组患者基线资料、手术时间、出血量、住院时间、术前和末次随访时颈部疼痛视觉模拟评分(VAS)、寰椎侧块位移的距离(LMD)及术中、术后并发症发生情况。结果两组术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获12~55个月(平均21.8个月)随访。所有患者术后均未出现伤口裂开、感染。术后12个月左右所有患者骨折均获骨性愈合,颈部疼痛基本消失,颈部活动无明显受限。JeRP钢板组与微型钛板组患者住院时间分别为(13.9±2.2)、(14.2±2.9)d,两组间比较差异无统计学意义(P>0.05)。JeRP钢板组患者手术时间为(203.5±173.4)min,出血量为(167.3±138.6)mL,均显著多于微型钛板组的(121.5±50.5)min、(98.4±57.2)mL,两组间比较差异均有统计学意义(P<0.05)。JeRP钢板组术前LMD为(6.7±1.7)mm,VAS评分为(6.8±1.0)分,显著大于末次随访时的(0.7±0.6)mm、(0.7±0.6)分,差异均有统计学意义(P<0.05)。微型钛板组术前LMD为(6.6±1.5)mm,VAS评分为(6.7±0.9)分,显著大于末次随访时的(0.9±0.6)mm、(0.8±0.7)分,差异均有统计学意义(P<0.05)。但以上指标术前、末次随访时两组间比较差异均无统计学意义(P>0.05)。JeRP组有1例患者术后1周发现内固定物松动。微型钛板组有1例患�Objective To compare Jefferson-fracture reduction plate(JeRP)and micro titanium plate in thetransoral single-segmentfixation of unstableatlas fractures.MethodssFrom January2008to December 2020,45 patients with unstable atlas fracture were treated by single-segment fixation through an oral approach with a JeRP or a micro titanium plate at Department of Orthopedic Surgery,General Hospital of Southern Theatre Command.They were 24 males and 21 females,aged from 15 to 67 years.By the Gehweiler classification,1l atlas fractures were type I and 34 type II;by the American Spinal Injury Association(ASIA)classification,the spinal cord injury was grade D in 7 cases and grade E in 38 cases;by the Dickman classification,the atlas transverse ligament injury was type I in 4 cases and type II in 1l cases.Of the patients,26 were treated by transoral single-segment fixation with a JeRP and 19 by transoral single-segment fixation with a micro titanium plate.The 2 groups were compared in terms of baseline data,operation time,blood loss,hospital stay,visual analog scale(VAS)for neck pain and atlas lateral mass displacement(LMD)before operation and at the last follow-up,and intraoperative and postoperative complications.ResultsThe2groups were comparable because there was no significant difference between them in the preoperative general data(P>0.05).All patients were followed up for 12 to 55 months(mean,21.8months).Wound dehiscence or infection was observed in none of the patients after operation.About 12 months after operation,all fractures achieved bony union,neck pain basically disappeared,and neck movement had no obvious limitation.The hospital stay was(13.9±2.2)d for the JeRP group and(14.2±2.9)d for the micro titanium plate group,showing no significant difference between the 2 groups(P>0.05).The operation time was(203.5±173.4)min and the blood loss(167.3±138.6)mL in the JeRP group,significantly more than those in the micro titanium plate group[(121.5±50.5)min and(98.4±57.2)mL](P<0.05).In the JeRP group,the preoperative LMD

关 键 词：寰枢关节 寰枕关节 脊髓损伤 经口咽入路 寰椎骨折 JeRP钢板 微型钛板 

分 类 号：R687.3[医药卫生—骨科学]