CAJ | 학술논문

目的探讨后路寰枢椎椎弓根钉棒内固定非融合治疗不适合前路齿突螺钉固定的Ⅱ型齿突骨折以保留寰枢椎旋转功能的临床疗效.方法 2012至2013年期间,选取13例不适合行前路齿突螺钉固定的Ⅱ型齿突骨折患者,男10例,女3例;年龄18～62岁,平均40岁.采用一期寰枢椎后路椎弓根钉棒复位内固定,术中不进行植骨融合,术后复查CT显示骨折骨性愈合后取出内固定,在内固定拆除至少1个月后采用动力位CT评估寰枢椎及颈椎总体旋转活动度的保留情况,采用文献报道的颈椎总体旋转活动度正常值作为历史对照.结果 13例患者成功置入直径3.5 mm的寰枢椎椎弓根螺钉共计52枚,螺钉长度为24～28 mm.术中骨折复位满意,未发生脊髓及椎动脉损伤等严重并发症.所有患者均得到随访,随访时间7～20个月,平均(14.2 ± 4.5)个月.术后骨折骨性愈合时间6～15个月,平均(9.0±2.8)个月.骨折骨性愈合即行二期手术拆除内固定,期间无内固定失败.手术前后患者颈痛症状明显改善,视觉模拟疼痛评分(visual analogue pain score,VAS)自术前平均(7.5±1.0)分(6～9分)下降至内固定拆除术后末次随访的(2.3±0.6)分(1～3分),差异有统计学意义.动力位CT显示术后寰枢椎旋转活动度平均向左17.0°、向右17.2°,寰枢椎总体旋转活动度平均为34.2°;术后颈椎旋转活动度平均向左59.7°、向右56.8°,颈椎总体旋转活动度平均为116.5°.术后寰枢椎总体旋转活动度下降至颈椎总体旋转活动度的27.3％,颈椎总体旋转活动度下降至同年龄组、同性别正常人群的78.2％.结论后路寰枢椎椎弓根内固定非融合治疗不适合前路齿突螺钉固定的Ⅱ型齿突骨折可以在一定程度上保留寰枢椎的旋转活动度.
목적 탐토후로환추추추궁근정봉내고정비융합치료불괄합전로치돌라정고정적Ⅱ형치돌골절이보류환추추선전공능적림상료효.방법 2012지2013년기간,선취13례불괄합행전로치돌라정고정적Ⅱ형치돌골절환자,남10례,녀3례;년령18～62세,평균40세.채용일기환추추후로추궁근정봉복위내고정,술중불진행식골융합,술후복사CT현시골절골성유합후취출내고정,재내고정탁제지소1개월후채용동력위CT평고환추추급경추총체선전활동도적보류정황,채용문헌보도적경추총체선전활동도정상치작위역사대조.결과 13례환자성공치입직경3.5 mm적환추추추궁근라정공계52매,라정장도위24～28 mm.술중골절복위만의,미발생척수급추동맥손상등엄중병발증.소유환자균득도수방,수방시간7～20개월,평균(14.2 ± 4.5)개월.술후골절골성유합시간6～15개월,평균(9.0±2.8)개월.골절골성유합즉행이기수술탁제내고정,기간무내고정실패.수술전후환자경통증상명현개선,시각모의동통평분(visual analogue pain score,VAS)자술전평균(7.5±1.0)분(6～9분)하강지내고정탁제술후말차수방적(2.3±0.6)분(1～3분),차이유통계학의의.동력위CT현시술후환추추선전활동도평균향좌17.0°、향우17.2°,환추추총체선전활동도평균위34.2°;술후경추선전활동도평균향좌59.7°、향우56.8°,경추총체선전활동도평균위116.5°.술후환추추총체선전활동도하강지경추총체선전활동도적27.3％,경추총체선전활동도하강지동년령조、동성별정상인군적78.2％.결론 후로환추추추궁근내고정비융합치료불괄합전로치돌라정고정적Ⅱ형치돌골절가이재일정정도상보류환추추적선전활동도.
Objective To observe the preliminary clinical results of temporary atlantoaxial segmental fixation for motion preservation of type Ⅱ dens fractures not amenable to anterior cancellous screw fixation.Methods Between 2012 and 2013,thirteen patients with type Ⅱ dens fractures not amenable to anterior screw fixation were enrolled and treated using temporary C1-2 pedicle screw fixation without fusion,including 10 males and 3 females,aging 18-62 years old (mean,40 years).The internal fixations were removed after the consolidation of the fractures was radiologically confirmed.Functional CT scan was carried out to evaluate residual atlantoaxial rotation and axial neck rotation at least one month after the implant removal.Results All of 52 pedicle screws were successfully placed and satisfactory fracture reduction was achieved and maintained by internal fixation in all of the 13 patients.No major complication was noted.The average follow-up time was 14.2 months (7 to 20 months).The fusion time after the surgery was 6 to 15 months,with an average of 9.0±2.8 months.At 9 months after initial surgery,the consolidation of the fractures was confirmed with no failure of fixation,and then the internal fixations were removed.The neck pain was released significantly,from preoperative VAS of 6 to 9 points (average,7.5± 1.0) to postoperative 1 to 3 points with an average of 2.3±0.6.The mean axial neck rotation was 59.7° to the left and 56.8° to the right.The mean atlantoaxial rotation was 17.0° to the left and 17.2° to the right.Total axial neck rotation was a mean of 116.5° and total atlantoaxial rotation was 34.2° on average.Atlantoaxial rotation took up about 27.3％ of total axial neck rotation.In comparison to age and gender matched normal individuals,total axial neck rotation was reduced to about 78.2％.Conclusion As an alternative to fusion,posterior reduction and temporary segmental fixation could be a feasible technique for the motion-preservative treatment of type Ⅱ dens fractures not amenable to anterior screw.