CAJ | 학술논문

目的评价带骨膜蒂枕骨外板翻转骨瓣在后路寰枢椎融合术中应用的可行性及其疗效.方法自2010年3月至2013年6月,对27例寰枢椎失稳患者在寰枢椎椎弓根钉棒系统内固定术中采用带骨膜蒂枕骨外板翻转骨瓣植骨融合,男16例,女11例;年龄23～56岁,平均45.6岁.12例新鲜齿状突骨折伴寰枢椎不稳(AndersonⅡ型9例、Ⅲ型3例),8例初次就诊时即有严重的骨折移位,4例轻度骨折移位行牵引复位、Halo-Vest支架固定后发生再移位;7例陈旧性齿突骨折伴寰椎前脱位(AndersonⅡ型5例、Ⅲ型2例);先天性游离齿突7例;类风湿关节炎1例.采用疼痛视觉模拟评分(visual analogue scale,VAS)、Frankel分级评估术前与术后轴性颈痛和神经功能情况,采用正中矢状位CT观察植骨融合情况.结果所有患者均顺利完成手术,手术时间90～140 min,平均100 min.术中出血量100～600ml,平均160 ml.术后随访18～39个月,平均32.6个月.骨性融合时间3个月19例、6个月7例、9个月1例.VAS评分由术前(7.23±1.65)分降低到末次随访的(2.87±1.03)分,差异有统计学意义.术前9例存在脊髓神经功能损害者末次随访时7例恢复至完全正常,2例术前Frankel分级C级末次随访时恢复至D级.术中损伤椎旁静脉丛1例,使用明胶海绵及脑棉片行压迫止血.术后复查CT提示1例患者寰椎左侧椎弓根螺钉位置偏外,1例患者枢椎左侧椎弓根螺钉位置偏外,均紧邻横突孔,但此2例患者均无临床症状,未予以特殊处理.结论带骨膜枕骨外板翻转骨瓣植骨是寰枢椎固定植骨融合的有效方法之一,具有可行性及安全性.
목적 평개대골막체침골외판번전골판재후로환추추융합술중응용적가행성급기료효.방법 자2010년3월지2013년6월,대27례환추추실은환자재환추추추궁근정봉계통내고정술중채용대골막체침골외판번전골판식골융합,남16례,녀11례;년령23～56세,평균45.6세.12례신선치상돌골절반환추추불은(AndersonⅡ형9례、Ⅲ형3례),8례초차취진시즉유엄중적골절이위,4례경도골절이위행견인복위、Halo-Vest지가고정후발생재이위;7례진구성치돌골절반환추전탈위(AndersonⅡ형5례、Ⅲ형2례);선천성유리치돌7례;류풍습관절염1례.채용동통시각모의평분(visual analogue scale,VAS)、Frankel분급평고술전여술후축성경통화신경공능정황,채용정중시상위CT관찰식골융합정황.결과 소유환자균순리완성수술,수술시간90～140 min,평균100 min.술중출혈량100～600ml,평균160 ml.술후수방18～39개월,평균32.6개월.골성융합시간3개월19례、6개월7례、9개월1례.VAS평분유술전(7.23±1.65)분강저도말차수방적(2.87±1.03)분,차이유통계학의의.술전9례존재척수신경공능손해자말차수방시7례회복지완전정상,2례술전Frankel분급C급말차수방시회복지D급.술중손상추방정맥총1례,사용명효해면급뇌면편행압박지혈.술후복사CT제시1례환자환추좌측추궁근라정위치편외,1례환자추추좌측추궁근라정위치편외,균긴린횡돌공,단차2례환자균무림상증상,미여이특수처리.결론 대골막침골외판번전골판식골시환추추고정식골융합적유효방법지일,구유가행성급안전성.
Objective To evaluate the feasibility and efficacy of atlantoaxial fusion by flipping periosteum pedicle occipital outer plate.Methods Between March 2010 and June 2013,27 patients with atlantoaxial instability were treated by atlantoaxial fusion with flipping periosteum pedicle occipital outer plate and combining pedicle screws fixation.There were 16 males and 11 females with the age ranging from 23 to 56 years (with an average of 45.6 years) at time of surgery.There were 12 cases of fresh odontoid fracture with atlantoaxial instability,7 cases of old odontoid fracture combined with uneducable atlantoaxial dislocation,7 cases of congenital loose of odontoid process,and 1 case of rheumatoid arthritis.The visual analog scale (VAS) scores and Frankel grades were respectively used to evaluate the axial neck pain and the neurological deficit,and the results were compared before and after the operation.Bony fusion was observed by the midline sagittal CT scan images.Results All the patients were successfully operated.The operation time was 90 to 140 mins (with an average of 100 mins),and the blood loss was 100 to 600 ml (with an average of 160 ml).All patients were followed up for 18 to 39 months,with an average of 32.6 months.19 cases got solid fusion 3 months after surgery,and 7 cases got solid fusion 6 months after surgery,while 1 case got solid fusion 9 months after surgery.The average VAS score at final follow-up was 2.87± 1.03,which was significantly lower than that preoperatively 7.23± 1.65.Before the operation,nine cases presented spinal nerve function damage.At the final follow up time,7 cases returned to complete normal and 2 cases improved from grade C to grade D according to the Frankel classification.1 case was complicated with veiniplex injury with no heavy blood loss,due to successful hemostasia.Two screws were placed close to the vertebral artery canal,without clinical consequences.Conclusion The flipping periosteum pedicle occipital outer plate as a bone graft is one effective method for atlantoaxial fusion,which got great feasibility and safety.