中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2011年
2期
128-132
,共5页
王长昇%史艳光%许卫红%罗鸿斌%李贵双
王長昇%史豔光%許衛紅%囉鴻斌%李貴雙
왕장승%사염광%허위홍%라홍빈%리귀쌍
寰枢关节%骨折固定术,内%椎弓根螺钉
寰樞關節%骨摺固定術,內%椎弓根螺釘
환추관절%골절고정술,내%추궁근라정
Atlanto-axial joint%Fracture fixation,internal%Pedical screw
目的 探讨寰枢椎椎弓根钉棒系统内固定手术治疗牵引复位不稳定型寰枢椎脱位的手术技巧及临床疗效.方法 选择2005年3月-2009年9月收治的寰枢椎脱位患者32例(TOI分型为T2型).其中齿状突骨折19例,新鲜性17例,陈旧性2例;横韧带断裂5例;先天性齿状突发育异常8例.术前日本骨科学会(JOA)评分5~13分,平均8.38分;骨髓有效空间(space available for the cord,SAC)平均9.15 mm.32例患者经颅骨牵引复位后,经颈后路行寰枢椎椎弓根钉棒系统内固定术.结果 32例患者经颅骨牵引后复位,共置入螺钉128枚,手术时间平均1.5 h,出血量平均300 ml,未发生椎动脉及脊髓损伤.全部患者获随访,时间12~24个月,临床症状获得不同程度改善.术后SAC平均14.86 mm;术后1年JOA评分10~17分,平均14.56分,评分改善率为71.70%.X线、螺旋CT复查螺钉位置良好,无钉棒断裂、变形、松动或寰枢椎再次脱位现象.寰枢椎后方植骨于术后3~6个月获骨性融合,1例未植骨,术后1年取出内固定,寰枢关节旋转功能正常.结论 寰枢椎椎弓根钉棒系统内固定技术为寰枢椎提供坚强的三维固定,可直视下置钉,术中复位、融合率高,安全有效,是牵引复位不稳定型寰枢椎脱位的理想治疗方法.
目的 探討寰樞椎椎弓根釘棒繫統內固定手術治療牽引複位不穩定型寰樞椎脫位的手術技巧及臨床療效.方法 選擇2005年3月-2009年9月收治的寰樞椎脫位患者32例(TOI分型為T2型).其中齒狀突骨摺19例,新鮮性17例,陳舊性2例;橫韌帶斷裂5例;先天性齒狀突髮育異常8例.術前日本骨科學會(JOA)評分5~13分,平均8.38分;骨髓有效空間(space available for the cord,SAC)平均9.15 mm.32例患者經顱骨牽引複位後,經頸後路行寰樞椎椎弓根釘棒繫統內固定術.結果 32例患者經顱骨牽引後複位,共置入螺釘128枚,手術時間平均1.5 h,齣血量平均300 ml,未髮生椎動脈及脊髓損傷.全部患者穫隨訪,時間12~24箇月,臨床癥狀穫得不同程度改善.術後SAC平均14.86 mm;術後1年JOA評分10~17分,平均14.56分,評分改善率為71.70%.X線、螺鏇CT複查螺釘位置良好,無釘棒斷裂、變形、鬆動或寰樞椎再次脫位現象.寰樞椎後方植骨于術後3~6箇月穫骨性融閤,1例未植骨,術後1年取齣內固定,寰樞關節鏇轉功能正常.結論 寰樞椎椎弓根釘棒繫統內固定技術為寰樞椎提供堅彊的三維固定,可直視下置釘,術中複位、融閤率高,安全有效,是牽引複位不穩定型寰樞椎脫位的理想治療方法.
목적 탐토환추추추궁근정봉계통내고정수술치료견인복위불은정형환추추탈위적수술기교급림상료효.방법 선택2005년3월-2009년9월수치적환추추탈위환자32례(TOI분형위T2형).기중치상돌골절19례,신선성17례,진구성2례;횡인대단렬5례;선천성치상돌발육이상8례.술전일본골과학회(JOA)평분5~13분,평균8.38분;골수유효공간(space available for the cord,SAC)평균9.15 mm.32례환자경로골견인복위후,경경후로행환추추추궁근정봉계통내고정술.결과 32례환자경로골견인후복위,공치입라정128매,수술시간평균1.5 h,출혈량평균300 ml,미발생추동맥급척수손상.전부환자획수방,시간12~24개월,림상증상획득불동정도개선.술후SAC평균14.86 mm;술후1년JOA평분10~17분,평균14.56분,평분개선솔위71.70%.X선、라선CT복사라정위치량호,무정봉단렬、변형、송동혹환추추재차탈위현상.환추추후방식골우술후3~6개월획골성융합,1례미식골,술후1년취출내고정,환추관절선전공능정상.결론 환추추추궁근정봉계통내고정기술위환추추제공견강적삼유고정,가직시하치정,술중복위、융합솔고,안전유효,시견인복위불은정형환추추탈위적이상치료방법.
Objective To explore the technique and clinical outcome of the atlantoaxial pedicle screw system in the treatment of the unstable atlantoaxial dislocation post traction.Methods The study involved 32 patients with atlantoaxial dislocation(type T2 of TOI classification)admitted from March 2005 to September 2009.There were 17 patients with fresh odontoid fracture and two with old odontoid fracture,five with traumatic disruption of the transverse atlantal ligament and eight with congenital odontoid dysplasia.JOA scores of neurological function before operation was at a range of 5-13(average 8.38).The average of space available for the cord(SAC)was 9.15 mm.Before the atlantoaxial pedicle screw system was carried out,the skull traction was performed in all the patients preoperatively.Results A total of 128 pedicle screws were inserted safely,with mean operation time and perioperative blood loss for 1.5 hours and 300 ml,respectively.No injury to the vertebral artery or spinal cord was observed.All the patients were followed up for 12-24 months,which showed that JOA scores one year after operation was increased to 10-17(average 14.56),with the improvement rate of 71.70%,and that the SAC was average 14.86 mm.The X-ray and SCT scans verified the proper position of the screws,with no internal fixation failure or atlantoaxial redislocation.After 3-6 months,all the patients except for one patient achieved a solid bone fusion.One year after operation,the one patient with no bone graft fusion was removed of the internal fixation system and obtained satisfactory restoration of the rotational function.Conclusions Atlantoaxial pedicle screw system is an effective method for the treatment of the unstable atlantoaxial dislocation post traction,for it has the advantages of stable three-dimension fixation,direct screw placement,intraoperative reduction and high fusion rate.