CAJ | 학술논문

目的介绍Jefferson骨折复位钢板系统(Jefferson-fracture reduction plate,JeRP)及其相关参数,评估其改良前后的临床疗效.方法对Jefferson骨折患者应用螺旋CT三维重建排除寰椎横韧带断裂后,采用原型JeRP系统进行手术治疗,分析其初步临床应用的疗效及出现的问题.根据应用中的不足,通过寰椎三维重建模型,进行应用解剖学研究并测量相关解剖数据,重新确定寰椎侧块上、下位螺钉的最佳进钉点和长度,根据该数据设计、改良JeRP钢板并予以临床应用.术后采用颈椎过伸、过屈位X线片评估是否存在寰枢椎不稳,应用CT扫描观察骨折愈合情况.结果 8例Jefferson骨折患者行经口咽寰椎骨折复位、原型JeRP钢板内固定术,术后平均随访6.3个月,所有患者术后枕颈部疼痛逐渐改善,咽后壁切口愈合良好,未见感染,骨折均达到解剖复位及骨性愈合,术后随访未见寰枢椎失稳,但其中3例患者因寰椎侧块上位螺钉穿破寰枕关节而导致颈椎活动受限.针对此问题,并通过应用解剖学测量,模拟置钉显示寰椎侧块外1/3平分线与寰椎上、下关节面交点所形成线段的中点作为寰椎侧块上位螺钉的进钉点,可保证JeRP钢板侧块上位螺钉不穿透上关节面,同时可保证足够空间置入下位螺钉,具备临床可行性.根据此结果设计出改良JeRP钢板,应用于4例Jefferson骨折患者,术后影像学检查证实所有螺钉均位于寰椎的侧块中.结论原型JeRP初步应用显示较好的疗效,但仍存在寰椎侧块上位螺钉穿透寰枕关节的可能;改良后钢板的设计更加符合寰椎的解剖结构,基本可以保证螺钉位于侧块中.
목적 개소Jefferson골절복위강판계통(Jefferson-fracture reduction plate,JeRP)급기상관삼수,평고기개량전후적림상료효.방법 대Jefferson골절환자응용라선CT삼유중건배제환추횡인대단렬후,채용원형JeRP계통진행수술치료,분석기초보림상응용적료효급출현적문제.근거응용중적불족,통과환추삼유중건모형,진행응용해부학연구병측량상관해부수거,중신학정환추측괴상、하위라정적최가진정점화장도,근거해수거설계、개량JeRP강판병여이림상응용.술후채용경추과신、과굴위X선편평고시부존재환추추불은,응용CT소묘관찰골절유합정황.결과 8례Jefferson골절환자행경구인환추골절복위、원형JeRP강판내고정술,술후평균수방6.3개월,소유환자술후침경부동통축점개선,인후벽절구유합량호,미견감염,골절균체도해부복위급골성유합,술후수방미견환추추실은,단기중3례환자인환추측괴상위라정천파환침관절이도치경추활동수한.침대차문제,병통과응용해부학측량,모의치정현시환추측괴외1/3평분선여환추상、하관절면교점소형성선단적중점작위환추측괴상위라정적진정점,가보증JeRP강판측괴상위라정불천투상관절면,동시가보증족구공간치입하위라정,구비림상가행성.근거차결과설계출개량JeRP강판,응용우4례Jefferson골절환자,술후영상학검사증실소유라정균위우환추적측괴중.결론 원형JeRP초보응용현시교호적료효,단잉존재환추측괴상위라정천투환침관절적가능;개량후강판적설계경가부합환추적해부결구,기본가이보증라정위우측괴중.
Objective To introduce the design,modification and clinical application of Jefferson-fracture reduction plate (JeRP),which was designed for the surgical treatment of Jefferson-fracture of the atlas,and evaluate the clinical effects.Methods JeRP system was designed for the treatment of patients with Jefferson fractures without rupture of the transverse ligament.Eight patients were treated operatively with the JeRP system for reduction and fixation of the fracture.Three-dimensional spiral CT was used to determine the integrity of the transverse ligament.During the preliminary clinical application,the clinical results were satisfied.But there were some disadvantages.The entry point of the superior screw of the mass was much too high,causing the screw penetrate into the atlantooccipital joint.Three-dimension Computed tomography images were used to analyze the anatomic characters of atlas.The relative anatomic parameter of the atlas was obtained.According to it,the Jefferson-fracture reduction plate was modified.The modified JeRP was applied clinically in another 4 patients.Extension and flexion X-ray were used to determine whether there was atlatoaxial dislocation after the operation.CT was used to determine whether there was bony fusion.Results Eight patients with Jefferson fractures without rupture of the transverse ligament were treated with the original JeRP.The mean follow-up time was 6.3 months.Neck pain was significantly alleviated after surgery in all patients.There was no infection or wound breakage.The reduction of the fracture was satisfied in all patients.Bony fusion was achieved in 3 months.No atlantoaxial dislocation was found in all patients during follow-up.Of the 8 patients,three complained about the movement restriction of the neck.The radiological examination found the upper screw of lateral mass breaking into the atlas-occipital joint.Anatomic structure of C1 lateral mass was measured using 1 mm CT scans.The optimal entry points and other parameters for the screws of the mass were determined.According to the anatomic parameters,we modified the JeRP.Another 4 patients with Jefferson fractures without rupture of the transverse ligament were treated operatively using this modified JeRP system.The preliminary clinical results were satisfactory.No screw penetrating into the atlas-occipital joint happened.Conclusion Although the preliminary results of the application of JeRP were satisfactory,there was a high ratio of atlas-occipital joint violated during lateral mass screw insertion.The modified JeRP can avoid this complication.