| 保国锋△,陈佳佳△,李卫东,徐冠华,孙郁雨,崔志明*.基于术中三维影像的经皮枢椎椎弓根螺钉内固定治疗Hangman骨折[J].脊柱外科杂志,2019,17(4):230-234,287. |
基于术中三维影像的经皮枢椎椎弓根螺钉内固定治疗Hangman骨折  点此下载全文 (Fulltext) |
| 保国锋△ 陈佳佳△ 李卫东 徐冠华 孙郁雨 崔志明* |
| 南通大学第二附属医院脊柱外科, 南通 226001 |
| 基金项目：中国博士后科学基金面上资助（2017M611885）；江苏省“六个一工程”拔尖人才科研项目（LYG2017038）；江苏省青年医学重点人才项目（QNRC2016410）；南通市科技项目（MS32017014） |
| DOI：10.3969/j.issn.1672-2957.2019.04.002 |
| 摘要点击次数: 587 |
| 全文下载次数: 245 |
| 摘要： |
| 目的 探讨基于术中三维影像的经皮枢椎椎弓根螺钉内固定治疗Hangman骨折的精准性和可行性。方法 2015年11月—2016年11月，在O形臂X线机引导下采用经皮椎弓根螺钉内固定治疗Hangman骨折患者12例（微创组），其中4例行单侧C2椎弓根螺钉内固定，8例行双侧C2椎弓根螺钉内固定；同期在C形臂X线机引导下开放手术治疗Hangman骨折患者10例（开放组），均行C2椎弓根螺钉和C3侧块螺钉内固定植骨融合术。记录手术时间、术中辐射剂量、出血量、螺钉精准度、术前和术后6个月颈部疼痛视觉模拟量表（VAS）评分及颈椎功能障碍指数（NDI）。结果 所有手术顺利完成，所有患者随访>6个月。微创组手术时间及术中出血量均低于开放组，但术中透视辐射剂量明显高于开放组，差异均有统计学意义（P<0.05）。微创组术后6个月VAS评分及NDI均优于开放组，差异均有统计学意义（P<0.05）。2组共置入螺钉60枚，其中C2椎弓根螺钉40枚，C3侧块螺钉20枚，均无螺钉相关的神经、血管损伤。术后1级螺钉，微创组有85%（17/20），开放组有80%（32/40），组间比较差异无统计学意义（P>0.05），且2组均无3级螺钉。结论 联合微创和术中三维成像技术，可以安全精准地治疗Hangman骨折，并可降低软组织剥离损伤和术中出血量，可以作为Hangman骨折微创治疗的选择之一。 |
| 关键词：颈椎 脊柱骨折 脊柱融合术 内固定器 外科手术,微创性 |
| Percutaneous minimally invasive axial pedicle screw fixation for Hangman's fracture based on intraoperative three-dimensional fluoroscopy Fulltext |
| BAO Guo-feng△ CHEN Jia-jia△ LI Wei-dong XU Guan-hua SUN Yu-yu CUI Zhi-ming* |
| Department of Spinal Surgery, Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the accuracy and feasibility of percutaneous minimally invasive axial pedicle screw fixation based on three-dimensional intraoperative fluoroscopy in the treatment of Hangman's fracture. Methods From November 2015 to November 2016, 12 patients with Hangman's fracture were treated with percutaneous minimally invasive pedicle screw fixation under the guidance of O-arm X-ray machine(minimally invasive group), of whom 4 underwent unilateral C2 pedicle screw fixation and 8 bilateral C2 pedicle screw fixation. In the same period, 10 patients with Hangman's fracture were treated with open surgery under the guidance of C-arm X-ray machine(open group), and all the patients underwent C2 pedicle screw and C3 lateral mass screw internal fixation and bone graft fusion. The operation time, intraoperative radiation dose, blood lo ss, screw accuracy, cervical pain visual analogue scale(VAS) score and neck disability index(NDI) at pre-operation and postoperative 6 months were recorded. Results All the operations were successfully completed and all the patients were followed up for more than 6 months. The operation time and blood loss in the minimally invasive group were lower than those in the open group, but the intraoperative fluoroscopy radiation dose was significantly higher than that in the open group, and the differences were statistically significant(P<0.05). The VAS score and NDI at postoperative 6 months of the minimally invasive group were better than those of the open group, and the differences were statistically significant(P<0.05). There were 60 screw implants in the 2 groups, including 40 C2 pedicle screw and 20 C3 lateral mass screw. There were no screw-related nerve and blood vessel injuries. There was 85%(17/20) grade 1 screw in the minimally invasive group and 80%(32/40) in the open group, without significant difference(P>0.05), and there was no grade 3 screw in both groups. Conclusion The combination of minimally invasive and intraoperative three-dimensional imaging technology can safely and accurately treat Hangman's fracture with minimal soft tissue dissection and blood loss, thus can be used as one of the minimally invasive treatment options for Hangman's fracture. |
| Keywords:Cervical vertebrae Spinal fractures Spinal fusion Internal fixators Surgical procedures,minimally invasive |
|
|
HTML
查看全文 查看/发表评论 下载PDF阅读器 |
