口咽入路小钛板固定治疗不稳定寰椎骨折的可行性分析  

Feasibility analysis of small titanium plate fixation through oropharyngeal approach in the treatment of unstable atlas fracture

作　　者：段连鸿[1] 韩珩[1] 曾云[1] 何宁[1] DUAN Lianhong;HAN Heng;ZENG Yun;HE Ning(Department of Orthopaedics,Sinopharm Dongfeng General Hospital,Hubei University of Medicine,Shiyan 442008,China)

机构地区：[1]湖北医药学院附属国药东风总医院骨科,442008

出　　处：《天津医药》2023年第11期1262-1266,共5页Tianjin Medical Journal

摘　　要：目的 研究口咽入路小钛板固定治疗不稳定寰椎骨折的可行性分析。方法 选取64例不稳定寰椎骨折患者,其中30例采用口咽入路小钛板固定治疗为观察组,34例采用后路寰枢椎椎弓根钉内固定治疗为对照组。比较2组术中指标:手术时间、出血量;术后指标:住院时间、并发症(颈部慢性疼痛、切口感染、吞咽困难)发生情况,术前、术后1个月、末次随访的疼痛视觉模拟(VAS)评分、日本骨科协会(JOA)评分以及颈椎后伸、前屈、左旋、右旋活动度。结果 观察组手术时间、出血量均显著低于对照组(P<0.05),住院时间差异无统计学意义;2组颈部慢性疼痛、切口感染和吞咽困难发生率差异无统计学意义;2组术后1个月、末次随访VAS评分低于术前,JOA评分高于术前(P<0.05),组间比较差异均无统计学意义;2组术后1个月、末次随访后伸、前屈、左旋、右旋活动度均较术前增加(P<0.05);观察组术后1个月、末次随访后伸、前屈、左旋、右旋活动度均高于对照组(P<0.05)。结论 口咽入路小钛板固定治疗不稳定寰椎骨折创伤小,手术时间短,且较传统后路寰枢椎椎弓根钉内固定治疗能够最大程度上保留颈椎活动度。Objective To study the feasibility of small titanium plate fixation through oropharyngeal approach in the treatment of unstable atlas fracture.Methods Sixty-four patients with unstable atlas fracture were selected,of which 30 patients were treated with small titanium plate fixation through oropharyngeal approach were used as the observation group,and 34 patients were treated with posterior atlantoaxial pedicle screw internal fixation were used as the control group.Intraoperative indexes including operation time,blood loss,postoperative indicators,length of hospital stay,occurrence of complications(chronic neck pain,incision infection and dysphagia),visual analogue pain(VAS)score,Japanese Orthopaedic Association(JOA)score before surgery,1 month after surgery and at the last follow-up and cervical extension,flexion,left and right rotation range of motion were compared between the two groups.Results The operation time and blood loss were significantly lower in the observation group than those in the control group(P<0.05),and there was no significant difference in the length of hospital stay between the two groups.There were no significant differences in the incidence of chronic neck pain,incision infection and dysphagia between the two groups.The VAS score was lower and the JOA score was higher 1 month after surgery and at the last follow-up than those before surgery(P<0.05),and there was no significant difference between the two groups.The extension,flexion,dextral and dextral movements were all increased one month after surgery and at the last follow-up in the two groups(P<0.05).The cervical extension,flexion,left rotation and right rotation of the observation group were higher than those of the control group one month after surgery and the last follow-up(P<0.05).Conclusion The oropharyngeal approach with small titanium plate fixation for unstable atlantic fracture is less invasive and shorter operation time,and can retain cervical spine mobility to the greatest extent than traditional posterior atlantoaxial pedic

关 键 词：骨折固定术 内 颈寰椎 口咽 钛 手术后期间 

分 类 号：R687.3[医药卫生—骨科学]