| 李小峰,赵朵,李炜峰,杨渊.后路椎弓根螺钉单节段内固定治疗寰椎骨折[J].脊柱外科杂志,2019,17(6):379-382. |
后路椎弓根螺钉单节段内固定治疗寰椎骨折  点此下载全文 (Fulltext) |
| 李小峰1 赵朵2 李炜峰3 杨渊4* |
1. 广西骨伤医院脊柱外科, 南宁 530012;
2. 广西医科大学第二附属医院骨科, 南宁 530000;
3. 深圳市罗湖区中医院骨科, 深圳 518021;
4. 广西医大开元埌东医院骨科, 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）；广西骨伤医院院级重点课题（GXGSZD-2019002） |
| DOI：10.3969/j.issn.1672-2957.2019.06.003 |
| 摘要点击次数: 565 |
| 全文下载次数: 260 |
| 摘要： |
| 目的 探讨后路椎弓根螺钉单节段内固定治疗寰椎骨折的临床疗效。方法 回顾性分析2008年1月-2017年6月在广西骨伤医院采用后路椎弓根螺钉单节段内固定治疗的25例寰椎骨折患者临床资料。记录手术时间、术中出血量及并发症发生情况，比较术前、术后1周及末次随访时寰椎侧块移位（LMD）、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、功能活动等情况。采用Frankel分级评估患者神经功能。结果 所有手术顺利完成。患者随访6~72个月，平均41个月，均获得骨性融合。手术时间为80~120 min，平均76 min；术中出血量为100~300 mL，平均150 mL。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）。1例术前Frankel分级D级患者恢复至E级；其余24例仍为E级。术中2例患者在剥离寰椎后弓下缘时损伤静脉丛，用明胶海绵压迫止血；术后1例患者CT检查示螺钉突破椎弓根内侧骨皮质，但无神经症状。所有患者末次随访时未见明显复位丢失，钢板内固定在位、牢靠。结论 后路椎弓根螺钉单节段内固定治疗寰椎骨折可有效维持枕-寰-枢复合体高度，维持寰椎环完整性及稳定性，临床疗效确切。 |
| 关键词：寰椎 脊柱骨折 内固定器 |
| Treatment of atlas fracture with posterior pedicle screw single-segmental internal fixation Fulltext |
| LI Xiao-feng1 ZHAO Duo2 LI Wei-feng3 YANG Yuan4* |
1. Department of Spinal Surgery, Orthopaedic and Traumatology Hospital of Guangxi, Nanning 530012, Guangxi Zhuang Autonomous Region, China;
2. Department of Orthopaedics, Second Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi Zhuang Autonomous Region, China;
3. Department of Orthopaedics, Shenzhen Luohu District Hospital of Traditional Chinese Medicine, Shenzhen 518021, Guangdong, China;
4. 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 posterior pedicle screw single-segmental internal fixation in the treatment of atlas fracture. Methods From January 2008 to June 2017,the clinical data of 25 patients with atlas fractures treated with posterior pedicle screw single-segmental internal fixation in Orthopaedic and Traumatology Hospital of Guangxi were analyzed restrospectively. Operation time,intraoperative blood loss and complication were recorded. The atlas lateral mass displacement(LMD),the vertical distance from the midpoint of axial inferior edge of vertebral body to the base line(R-J line),Japanese Orthopaedic Association(JOA) score,pain visual analog scale(VAS) score were compared to evaluate patient's pain intensity,fracture healing,functional activities at pre-operation,postoperative 1 week and the final follow-up. Neurological function was assessed by Frankel classification. Results All the operations completed successfully. All the patients were followed up for 6-72 months(mean 41 months),and bone fusion was achieved in all the patients. The operation time was 80-120 min(mean 76 min),and the intraoperative blood loss was 100-300 mL(mean 150 mL). 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 D to E in 1 case,and the remaining 24 were still E. During the operation,2 patients suffered injury of the venous plexus when the inferior edge of posterior arch of the atlas was exfoliated,and bleeding was stopped after compression with gelatin sponge. Postoperative CT examination showed that screw broke through the medial vertebral cortex of the pedicle,but without neurological symptoms in 1 patient. At the final follow-up,there was no obvious reduction loss,and steel plate internal fixation was in place steadily. Conclusion The treatment of atlas fractures with posterior pedicle screw single-segmental internal fixation can effectively maintain the height of the occipito-atlanto-axial complex,and maintain the integrity and stability of the atlas ring. |
| Keywords:Atlas Spinal fractures Internal fixators |
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