CAJ | 학술논문

目的：观察和分析比较寰椎新型环抱钩棒内固定系统与钉棒内固定系统治疗寰枢椎不稳的临床疗效及其安全性。方法随机选取2009年6月至2013年12月在郴州市第一人民医院脊柱外科因寰枢椎不稳行颈椎后路寰枢关节环抱钩棒内固定与钉棒内固定系统手术方式的患者进行比较。分为寰枢椎新型环抱钩棒内固定系统（A组）与钉棒内固定系统（B组），两组各22例。两组患者均采用自体髂骨植骨或人工骨植骨。观察和比较两组患者的术前JOA评分、手术时间、手术切口长度、术中出血量、术后切口引流量、住院天数、术后回访3个月、6个月、1年的JOA评分与植骨融合率、寰枢椎关节稳定性[测量寰齿前间隙（ADI）]情况。结果无1例患者因手术操作致椎动脉和脊髓损伤。两组患者术后均未发生肺部、泌尿系、伤口感染，顺利出院。44例患者随访6～12个月，平均（9±3）个月。全部患者植骨融合。两组患者的手术时间、手术切口长度、术中出血量、术后切口引流量、住院天数比较差异有统计学意义（P<0.05），具有可比性；术前、术后JOA评分、寰枢椎关节稳定性差异无统计学意义（P>0.05）。结论与寰枢椎后路钉棒系统内固定术相比，本术式操作安全简便，患者身体恢复较快；生物力学稳定性及植骨融合率较钉棒系统无明显差异；对寰椎后弓采用钩的固定，降低了医源性血管、神经损伤的风险；故该术式在寰枢椎后路植骨融合内固定术中是一种值得推广的手术方式。
목적：관찰화분석비교환추신형배포구봉내고정계통여정봉내고정계통치료환추추불은적림상료효급기안전성。방법수궤선취2009년6월지2013년12월재침주시제일인민의원척주외과인환추추불은행경추후로환추관절배포구봉내고정여정봉내고정계통수술방식적환자진행비교。분위환추추신형배포구봉내고정계통（A조）여정봉내고정계통（B조），량조각22례。량조환자균채용자체가골식골혹인공골식골。관찰화비교량조환자적술전JOA평분、수술시간、수술절구장도、술중출혈량、술후절구인류량、주원천수、술후회방3개월、6개월、1년적JOA평분여식골융합솔、환추추관절은정성[측량환치전간극（ADI）]정황。결과무1례환자인수술조작치추동맥화척수손상。량조환자술후균미발생폐부、비뇨계、상구감염，순리출원。44례환자수방6～12개월，평균（9±3）개월。전부환자식골융합。량조환자적수술시간、수술절구장도、술중출혈량、술후절구인류량、주원천수비교차이유통계학의의（P<0.05），구유가비성；술전、술후JOA평분、환추추관절은정성차이무통계학의의（P>0.05）。결론여환추추후로정봉계통내고정술상비，본술식조작안전간편，환자신체회복교쾌；생물역학은정성급식골융합솔교정봉계통무명현차이；대환추후궁채용구적고정，강저료의원성혈관、신경손상적풍험；고해술식재환추추후로식골융합내고정술중시일충치득추엄적수술방식。
ObjectiveTo observe and analyze the clinical efficacy and safety between surrounded atlanto-axial new hook rod fixation systems and nail rod fixation system on treatment atlanto-axial instability. MethodsRandomly selected patients from June 2009 to December 2013 at the First People's Hospital of Chenzhou City, spine surgery atlantoaxial instability due to cervical posterior atlantoaxial joint surrounded by the hook rod fixation and nail rod fixation system surgical approach for comparison. Divided into atlantoaxial embracing new hook rod fixation system (A group) and the screw-rod fixation system (group B), the two groups were all 22 cases. Two groups of patients were treated with autologous bone graft or bone graft. Observed and compared two groups of patients undergoing preoperative JOA score, operative time, incision length, amount of intra operative blood loss, postoperative wound drainage, hospital stay, postoperative visit 3 months, 6 months, 1 year JOA score and fusion rate, atlantoaxial joint stability (measured before atlantoodontoid gap ADI) situation. ResultsNo patient were vertebral artery and spinal cord injury which caused by surgical procedures. Two groups of patients did not occur the lungs, urinary tract, wound infection, was discharged. 44 cases were followed up for 6 to 12 months, an average of (9±3) months. There was significant difference between the two groups patients in operation time, incision length, intra operative blood loss, postoperative wound drainage ,hospital stay(P<0.05).There were no significant difference of the patients' preoperative and postoperative JOA scores and atlanto-axial joint stability (P>0.05).Conclusion Compared with the atlanto-axial nail rod fixation system technique,the surrounded atlanto-axial new hook rod fixation system is not only easy to operate but also more safer .There was no significant difference between biomechanical stability and fusion rate. Hooks is used to fixed in posterior arch of the atlas,reducing the risk of iatrogenic vascular, nerve injury. It is a worthy way to the procedure in the posterior atlantoaxial fusion and internal fixation surgery.