后路寰枢椎钉棒复位内固定联合枢椎棘突肌肉血管复合体移植治疗ⅡC型齿状突骨折的疗效观察  

Observation on the efficacy of posterior atlantoaxial screw rod reduction and internal fixation combined with transplantation of the muscle⁃vascular complex of the atlantoaxial spinous process in treatment of typeⅡC odontoid fractures

作　　者：洪庆南 郑耿阳 李达 卢宜哲 赵枫 HONG Qingnan;ZHENG Gengyang;LI Da;LU Yizhe;ZHAO Feng(Department of Orthopedics,the 910th Hospital of Joint Logistic Force of Chinese People′s Liberation Army,Quanzhou 362000,China)

机构地区：[1]联勤保障部队第910医院骨科,泉州362000

出　　处：《中国临床新医学》2024年第11期1238-1243,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：福建省自然科学基金项目(编号:2021Jq013519)。

摘　　要：目的观察后路寰枢椎钉棒复位内固定联合枢椎棘突肌肉血管复合体移植治疗ⅡC型齿状突骨折的疗效。方法回顾性分析2020年1月至2022年10月联勤保障部队第910医院收治的95例ⅡC型齿状突骨折患者的临床资料,根据患者手术方案不同将其分为对照组(接受后路寰枢椎钉棒复位内固定联合髂骨植骨术,47例)和观察组(接受后路寰枢椎钉棒复位内固定联合枢椎棘突肌肉血管复合体移植术,48例)。比较两组手术相关指标以及术后骨折愈合率、骨折端和颈部稳定性及寰枢椎旋转度。比较两组术前以及术后3个月、6个月的视觉模拟量表(VAS)评分、美国脊髓损伤协会(ASIA)评分、颈椎障碍指数(NDI)、日本矫形外科协会(JOA)评分。比较两组并发症发生情况。结果与对照组相比,观察组手术时间更短,术中出血量更少,骨折愈合时间更快,差异有统计学意义(P<0.05)。在术后6个月,观察组骨折愈合率显著高于对照组[93.75%(45/48)vs 78.72%(37/47);χ^(2)=4.540,P=0.033]。术后6个月,颈椎屈伸动态X线片显示观察组所有患者骨折端和颈部稳定性良好,对照组有4例患者骨折端稳定性欠佳。在骨折愈合后3个月,观察组和对照组寰枢椎旋转度差异无统计学意义[(84.13±6.32)°vs(82.96±7.10)°;t=0.849,P=0.398]。两组术后VAS评分均呈下降趋势(P<0.05),组间变化幅度差异无统计学意义(P>0.05)。与术前相比,两组术后3个月、6个月的ASIA评分均无显著变化(P>0.05)。两组术后NDI均呈下降趋势(P<0.05),在术后3个月、6个月,观察组NDI均显著低于对照组(P<0.05)。两组术后JOA评分均呈上升趋势(P<0.05);在术后3个月、6个月,观察组JOA评分均显著高于对照组(P<0.05)。观察组并发症发生率低于对照组,但差异无统计学意义[4.17%(2/48)vs 14.89%(7/47);χ^(2)=2.058,P=0.151]。结论后路寰枢椎钉棒复位内固定联合枢椎棘突肌肉血管复合体移植治疗ⅡC型齿状突骨折�Objective To observe the efficacy of posterior atlantoaxial screw rod reduction and internal fixation combined with transplantation of the muscle-vessel complex of the atlantoaxial spinous process in treatment of typeⅡC odontoid fractures.Methods The clinical data of 95 patients with typeⅡC odontoid fractures who were admitted to the 910th Hospital of Joint Logistic Force of Chinese People′s Liberation Army from January 2020 to October 2022 were retrospectively analyzed.The patients were divided into control group(receiving posterior atlantoaxial screw rod reduction and internal fixation combined with iliac bone grafting,47 cases),and observation group(receiving posterior atlantoaxial screw rod reduction and internal fixation combined with transplantation of the muscle-vascular complex of the atlantoaxial spinous process,48 cases).The operation-related indicators,postoperative fracture healing rate,fracture end and neck stability and atlantoaxial rotation degree were compared between the two groups.Visual Analogue Scale(VAS)scores,American Spinal Injury Association(ASIA)scores,neck disability index(NDI)and Japanese Orthopaedic Association(JOA)scores were compared between the two groups before operation,3 months after operation and 6 months after operation.The complications were compared between the two groups.Results Compared with the control group,the observation group had shorter operation time,less blood loss during operation,and shorter time to fracture healing,and the differences were statistically significant(P<0.05).The fracture healing rate in the observation group was significantly higher than that in the control group 6 months after operation[93.75%(45/48)vs 78.72%(37/47);χ^(2)=4.540,P=0.033].Six months after operation,dynamic X-ray films of cervical flexion and extension showed good stability of the fracture ends and necks in all the patients in the observation group,while four patients in the control group had poor stability of the fracture ends.There was no significant difference in the atlant

关 键 词：齿状突骨折 内固定 骨折愈合 枢椎棘突肌肉血管复合体 

分 类 号：R683.2[医药卫生—骨科学]