Hangman骨折两种气管插管全麻下短节段固定融合  

Two approaches of intratracheal intubation under general anesthesia for short-segment instrumented fusion of Hangman fractures

作　　者：方艳志 徐志强 迟寿远 肖维民 叶哲伟[1] 杨操[1] 杨北仁 吴星火[1] FANG Yan-zhi;XU Zhi-qiang;CHI Shou-yuan;XIAO Wei-min;YE Zhe-wei;YANG Cao;YANG Bei-ren;WU Xing-huo(Department of Orthopedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Anesthesiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;People's Hospital of Xishui County,Xishui 438299,China;Yichang Hospital of Traditional Chinese Medicine,Yichang 443000,China)

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,湖北武汉430022 [2]华中科技大学同济医学院附属协和医院麻醉科,湖北武汉430022 [3]浠水县人民医院,湖北浠水438299 [4]宜昌市中医院,湖北宜昌443000

出　　处：《中国矫形外科杂志》2023年第16期1482-1487,共6页Orthopedic Journal of China

摘　　要：[目的]比较两种气管插管全麻下短节段固定融合术治疗Hangman骨折的临床效果。[方法]回顾性分析2014年1月—2019年6月本院采用颈椎后路椎弓根螺钉固定融合治疗Hangman骨折的37例患者的临床资料。根据术前医患沟通结果,24例采用经口腔插管,另外13例采用经鼻腔插管。比较两组患者围手术期、随访及影像学资料。[结果]37例患者均顺利完成手术,术中无血管、神经损伤等并发症发生。经口组喉部暴露时间和插管时间显著少于经鼻组(P<0.05),但两组1次置管成功率的差异无统计学意义(P>0.05)。两组手术时间、切口长度、术中失血量、麻醉相关并发症、下地时间、切口愈合等级、住院时间等的差异均无统计学意义(P>0.05)。36例患者随访时间平均(16.2±6.7)个月,两组恢复完全负重活动时间的差异无统计学意义(P>0.05)。术后随时间推移,两组患者ASIA分级、NDI评分和JOA评分显著改善(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,两组置钉准确性的差异无统计学意义(P>0.05),与术前相比,末次随访两组颈椎前凸角、C2~3滑移率均显著改善(P<0.05),相应时间点,两组间颈椎前凸角、C2~3滑移率的差异无统计学意义(P<0.05)。[结论]采用后路短节段椎弓根螺钉内固定融合术治疗不稳定Hangman骨折可取得满意的临床疗效,两种麻醉插管方法均安全可行。[Objective]To compare the clinical outcomes of transoral(TO)versus transnasal(TN)intratracheal intubations under general anesthesia for short-segment instrumented fusion of Hangman's fractures.[Methods]A retrospective study was performed on 37 patients who received posterior cervical pedicle screw fixation and fusion for Hangman's fractures in our hospital from January 2014 to June 2019.According to the results of preoperative doctor-patient communication,24 patients underwent TO intubation,while the remaining 13 patients received TN intubation.The perioperative period,follow-up and imaging data of the two groups were compared.[Results]All the 37 patients had operations performed successfully with no complications such as vascular nerve injury during the operation.The TO group proved significantly less laryngeal exposure time and intubation time than the TN group(P<0.05),although there were no significant differences in the success rate of catheterization on the first time,operation time,incision length,intraoperative blood loss,anesthesia-related complications,postoperative ambulation time,incision healing,and hospital stay between the two groups(P>0.05).All of them in both groups were followed up for(16.2±6.7)months on a mean,and there was no significant difference in the time to return to full weight-bearing activities between the two groups(P>0.05).The ASIA grade for neurological function,NDI and JOA scores improved significantly in both groups over time(P<0.05),which were not significantly different between the two groups at any time points accordingly(P>0.05).Regarding image,there was no significant difference in screw placement accuracy between the two groups(P>0.05).The cervical lordotic angle and C2~3 slip ratio significantly improved in both groups at the latest follow-up compared with those preoperatively(P<0.05),which were not found significantly different between the two groups at any corresponding time points(P>0.05).[Conclusion]Posterior short-segment instrumented fusion does achieve satisfactory

关 键 词：HANGMAN骨折 麻醉 经口插管 经鼻插管 短节段固定融合 

分 类 号：R683.2[医药卫生—骨科学]