中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2010年
8期
691-694
,共4页
倪斌%周风金%郭翔%杨健%李松凯%朱庄臣%张锋%陈金水%王飞%刘军
倪斌%週風金%郭翔%楊健%李鬆凱%硃莊臣%張鋒%陳金水%王飛%劉軍
예빈%주풍금%곽상%양건%리송개%주장신%장봉%진금수%왕비%류군
寰枢关节%关节不稳定性%脊柱融合术
寰樞關節%關節不穩定性%脊柱融閤術
환추관절%관절불은정성%척주융합술
Atlant-axial joint%Joint instability%Spinal fusion
目的 分析后路钉棒系统术中复位内固定治疗在寰枢椎脱位的临床效果.方法 回顾分析2007年1月-2009年5月治疗的寰枢椎脱位患者27例,男18例,女9例;年龄13～51岁,平均31岁.其中,陈旧性齿状突骨折11例,齿状突游离小骨5例,寰椎横韧带断裂7例,类风湿性寰枢椎脱位4例.所有患者术前均难以获得良好复位,寰齿间距(atlantodens interval,ADI)8～15 mm,平均11mm.术中采用后路寰枢椎椎弓根螺钉固定,利用弯棒提拉进行复位,并行椎板间植骨.治疗前按美国脊髓损伤协会(ASIA)分级:B级8例,C级15例,D级4例.结果 随访时间6～24个月,平均13个月.所有患者枕颈部症状得到改善,均获得骨性融合.术后ADI为2～4 mm,平均2.8 mm.术后ASIA脊髓神经功能分级:C级4例,D级12例,E级11例.无椎动脉及脊髓神经损伤患者.无内固定脱落、断裂、退钉等并发症.结论 后路钉棒系统能够对寰枢椎脱位进行有效的术中复位,具有操作简单、并发症少、疗效确切的优点.
目的 分析後路釘棒繫統術中複位內固定治療在寰樞椎脫位的臨床效果.方法 迴顧分析2007年1月-2009年5月治療的寰樞椎脫位患者27例,男18例,女9例;年齡13～51歲,平均31歲.其中,陳舊性齒狀突骨摺11例,齒狀突遊離小骨5例,寰椎橫韌帶斷裂7例,類風濕性寰樞椎脫位4例.所有患者術前均難以穫得良好複位,寰齒間距(atlantodens interval,ADI)8～15 mm,平均11mm.術中採用後路寰樞椎椎弓根螺釘固定,利用彎棒提拉進行複位,併行椎闆間植骨.治療前按美國脊髓損傷協會(ASIA)分級:B級8例,C級15例,D級4例.結果 隨訪時間6～24箇月,平均13箇月.所有患者枕頸部癥狀得到改善,均穫得骨性融閤.術後ADI為2～4 mm,平均2.8 mm.術後ASIA脊髓神經功能分級:C級4例,D級12例,E級11例.無椎動脈及脊髓神經損傷患者.無內固定脫落、斷裂、退釘等併髮癥.結論 後路釘棒繫統能夠對寰樞椎脫位進行有效的術中複位,具有操作簡單、併髮癥少、療效確切的優點.
목적 분석후로정봉계통술중복위내고정치료재환추추탈위적림상효과.방법 회고분석2007년1월-2009년5월치료적환추추탈위환자27례,남18례,녀9례;년령13～51세,평균31세.기중,진구성치상돌골절11례,치상돌유리소골5례,환추횡인대단렬7례,류풍습성환추추탈위4례.소유환자술전균난이획득량호복위,환치간거(atlantodens interval,ADI)8～15 mm,평균11mm.술중채용후로환추추추궁근라정고정,이용만봉제랍진행복위,병행추판간식골.치료전안미국척수손상협회(ASIA)분급:B급8례,C급15례,D급4례.결과 수방시간6～24개월,평균13개월.소유환자침경부증상득도개선,균획득골성융합.술후ADI위2～4 mm,평균2.8 mm.술후ASIA척수신경공능분급:C급4례,D급12례,E급11례.무추동맥급척수신경손상환자.무내고정탈락、단렬、퇴정등병발증.결론 후로정봉계통능구대환추추탈위진행유효적술중복위,구유조작간단、병발증소、료효학절적우점.
Objective To evaluate the outcome of posterior screw-rod fixation system in reduction and internal fixation of atlantoaxial dislocation. Methods A retrospective study was done on 27 patients with atlantoaxial instability including 18 male and 9 female (at age range of 13-51 years, mean 31 years) from January 2007 to May 2009. There were 11 patients with chronic odontoid fractures, five with isolated bone odontoid, seven with transverse ligament rupture of atlas and four with rheumatoid arthritis. Skeletal reduction was performed in all the patients. The anterior atlantodens interval (ADI)ranged from 8 mm to 15 mm, average 11 mm. All the patients underwent an intraoperative reduction by posterior C1 lateral mass and C2 pedicle screws with rod fixation. According to American Spine Injury Association (ASIA) impairment scale, there were eight patients at grade B, 15 at grade C and four at grade D. Results All patients were followed up for 6-24 months (average 13 months), which showed that the neck symptoms were improved, with bony union. The ADI was reduced to 2-4 mm (average 2.8 mm)postoperatively. Postoperative ASIA scale was grade C in four patients, grade D in 12 and grade E in 11.There were no neurologic or vascular complications occurred, or no failure of the internal fixtors, pseudarthrosis or instability. Conclusion Posterior screw-rod fixation system has advantages of simple procedures, few complications and good results and can be used for intraoperative reduction of atlantoaxial dislocation.
