| 李小峰,冀晶,农桔安,杨渊.经口咽入路重建钢板单节段内固定治疗不稳定性寰椎骨折[J].脊柱外科杂志,2019,17(3):158-162. |
经口咽入路重建钢板单节段内固定治疗不稳定性寰椎骨折  点此下载全文 (Fulltext) |
| 李小峰1 冀晶1 农桔安2 杨渊1 3* |
1. 广西骨伤医院脊柱外科, 南宁 530012;
2. 南宁市第二人民医院骨科, 南宁 530000;
3. 广西医大开元琅东医院骨科, 南宁 530021 |
| 基金项目：广西医疗卫生重点科研课题（重2012026）；广西科学研究与技术开发计划项目（桂科攻1355005-6-4） |
| DOI：10.3969/j.issn.1672-2957.2019.03.002 |
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| 摘要： |
| 目的 探讨经口咽入路重建钢板单节段内固定治疗不稳定性寰椎骨折的临床疗效。方法 回顾性分析2008年1月-2017年12月广西骨伤医院采用经口咽入路重建钢板单节段内固定治疗的38例不稳定性寰椎骨折患者临床资料。记录手术时间，术中出血量，置入螺钉数量、尺寸及手术相关并发症，比较术前、术后1周及末次随访时寰椎侧块移位（LMD）、寰齿前间距（ADI）、枢椎椎体下缘中点到基底线垂直距离（R-J线）、日本骨科学会（JOA）评分、疼痛视觉模拟量表（VAS）评分等指标及改善率，评估患者疼痛程度、骨折愈合、活动功能等情况。采用Frankel分级评估患者神经功能。结果 所有手术顺利完成。所有患者随访6~70个月，平均38个月，均获得骨性融合。38例患者共置入螺钉81枚，包含空心加压螺钉（齿状凸螺钉）1枚，侧块螺钉平均长度23.6 mm。术后1周、末次随访时LMD、R-J线、VAS评分、JOA评分均较术前明显改善，差异有统计学意义（P < 0.05）。术前Frankel分级1例C级恢复至D级；2例D级1例恢复至E级，另1例无改善；其余35例仍为E级。末次随访未见明显复位丢失，钢板内固定在位、牢靠，1枚螺钉穿破侧块内侧皮质，但未出现明显神经症状。结论 经口咽入路重建钢板单节段内固定治疗不稳定性寰椎骨折可重建寰椎前弓，维持寰椎环的高度及稳定性，临床疗效确切。 |
| 关键词：寰椎 脊柱骨折 内固定器 |
| Treatment of unstable atlas fracture with reconstruction plate single-segmental internal fixation via oropharyngeal approach Fulltext |
| LI Xiao-feng1 JI Jing1 NONG Ju-an2 YANG Yuan1 3* |
1. Department of Spine Surgery, Orthopaedic and Traumatology Hospital of Guangxi, Nanning 530012, Guangxi Zhuang Autonomous Region, China;
2. Department of Orthopaedics, Second Nanning People's Hospital, Nanning 530000, Guangxi Zhuang Autonomous Region, China;
3. Department of Orthopaedics, Guangxi Medical University Kaiyuan Langdong Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the clinical efficiency of reconstruction plate single-segmental internal fixation through oropharyngeal approach in the treatment of unstable atlas fracture. Methods From January 2008 to December 2017,the clinical data of 38 patients with unstable atlas fractures treated with reconstruction plate single-segmental internal fixation through oropharyngeal approach in Orthopaedic and Traumatology Hospital of Guangxi were analyzed resrospectively. Operation time,intraoperative blood loss,number and size of screws and complications were recorded. The atlas lateral displacement(LDM),atlanto-dental interval(ADI),vertical distance from midpoint of inferior edge of the axial body to the base line(R-J line),Japanese Orthopaedic Association(JOA) score and pain visual analog scale(VAS) score were compared to evaluate patient's pain intensity,fracture healing,functional activity at pre-operation,postoperative 1 week and the final follow-up. Neurological function was assessed by Frankel classification. Results All the operation were completed successfully. All the patients were followed up for 6-70 months(mean 38 months),and bone fusion was achieved in all the patients. A total of 81 screws were implanted into 38 patients,including 1 hollow compression screw(dentate convex screw),and the average length of the lateral mass screw was 23.6 mm. LMD,R-J line,VAS score and JOA score were significantly improved at postoperative 1 week and the final follow-up,with statistically significant differences(P < 0.05). The Frankel classification grade was recovered from C to D in 1 case;D to E in 1,and the other 1 in D was not improved;the remaining 35 were still E. At the final follow-up,there was no obvious reduction loss,and steel plate internal fixation was in place;1 screw pierced the medial cortex of the lateral mass,but no obvious neurological symptoms were found. Conclusion The treatment of unstable atlas fractures with reconstruction plate single-segmental internal fixation through oropharyngeal approach can well reconstruct the anterior arch of the atlas,maintain the height and stability of the atlas ring. |
| Keywords:Atlas Spinal fractures Internal fixators |
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