摘要
目的:比较微创手术与传统开放手术治疗老年人上颈椎损伤的安全性和疗效。方法:1997年6月～2007年6月采用微创手术治疗上颈椎损伤患者25例,其中男22例,女3例;年龄60～86岁,平均70.3岁;新鲜齿状突骨折9例,陈旧性齿状突骨折2例,Hangman骨折5例,Jefferson骨折4例,C2、3骨折脱位3例,难复性C1、2脱位2例。同期采用传统开放手术治疗20例,其中男16例,女4例,年龄60～84岁,平均68.8岁;新鲜齿状突骨折6例,陈旧性齿状突骨折1例,Hangman骨折3例,Jefferson骨折2例,C2、3骨折脱位5例,难复性C1、2脱位3例。结果:随访6个月～10年,平均4.5年,其中死亡(与上颈椎损伤无关)5例,失访7例,得到随访微创组18例,开放组15例。微创组手术时间、术中出血量和术后下地时间明显优于开放组,而X线照射次数明显多于开放组(P<0.05)。微创组部分复位4例(齿状突骨折2例、Jefferson骨折2例),开放组部分复位3例(齿状突骨折1例、Jefferson骨折1例、难复性C1、2脱位1例),其余均达到满意复位。微创组术前、术后JOA评分和改善率分别为7.29±2.54分、14.37±1.40分及72.9%,开放组为6.88±2.13分、14.10±1.38分和71.2%,两组术后JOA评分较术前有明显改善(P<0.001),两组间改善率无显著性差异(P>0.05)。微创组术后和末次随访时VAS评分较术前明显降低(P<0.001),开放组术后与术前比较无显著性差异(P>0.05)、末次随访时较术前明显降低(P<0.001)。随访时微创组和开放组各有1例齿状突骨折纤维愈合,动力位X线片未显示骨折处移位,其余均获得骨折愈合或寰枢关节稳定。微创组螺钉尾过长置于C3椎体上缘2例,其余内固定位置满意。微创组并发症有暂时性喉上神经损伤1例,螺钉松动1例;开放组暂时性喉返神经损伤1例,钛网螺钉脱落1例,下肢深静脉血栓形成1例。结论:微创手术治疗老年人上颈椎损伤安全、有效,较传统开放手术有创伤小、出血少、疼痛轻和可早期进行功能训练等优点。
Objective：To compare the safety and surgical effect for mini-invasive surgery （MIS） with open surgery in treating the upper cervical injury in aged people.Method：Twenty-five patients experienced MIS from June 1997 to June 2007,including 22 male and 3 female with the average age of 70.3 years old（range, 60-86 years old）.Of these patients,there were 9 cases of odontoid fractures,2 of old odontoid fractures,5 of Hangman＇s fractures,4 of Jeffeson fractures,and 3 of fracture-dislocation at C2,3,and 2 of irreducible C1-2 dislocation.20 patients including 16 male and 4 female with age rangeing from 60 to 84 years old experienced traditional open surgery,of these,6 cases had odontoid fractures,1 had old odontoid fracture,3 had Hangman＇s fractures,2 had Jeffeson fractures,5 had fracture-dislocation at C2,3,and 3 hard irreducible C1-2 dislocation.Result：All patients were followed-up for an average of 4.5 years（range,6 months-10 years）. Five patients died of old age and 7 were lost follow-up.There were 18 patients in MIS group followed-up, while 15 patients in open surgery group followed-up.Compared with open surgery group,the MIS group had better results as for the operation time,the blood lose and the duration of bed rest.But the open surgery group had less exposure to the radiation.Complete reduction was achieved in all patients except of partial reduction on 2 odontoid fractures and 2 Jefferson fractures in MIS group and 1 odontoid fracture, 1 Jefferson fracture and 1 C1-2 old dislocation in open surgery group.The JOA score before and after surgery for the MIS was 7.29±2.54 and 14.37±1.40 respectively with the improve rate of 72.9%.For the open surgery group the JOA score before and after surgery was 6.88±2.13 and 14.10±1.38 respectively with the improve rate of 71.2%.Significant improvement were noted in both groups （P〈0.001）,however no significant difference between the two groups were noted.The VAS score significantly decreased after surgery and at follow up in MIS group;while in open surgery group,there were no difference as for VAS evaluation upon before and after surgery,with VAS decreasing at final follow-up （P〈0.001）.Radiographic fusion and stability of C1-2 was documented in all patients,except 1 non-union in MIS group and 1 non-union in open surgery group.All screws were in good position except of 2 evidenced too long in MIS group.Transient superior laryngeal nerve deficit was noted in 1,and screw loosening in 1 in MIS group;while in open surgery group,transient recurrent laryngeal nerve injury was found in 1 ,deep venous embolism of low limb in 1 ,and screw pull-out and cage displacement in 1.Conclusion：The MIS is reliable and effective for aged people in dealing with upper cervical injury,compared with conventional open surgery,MIS has the advantages of less invasive,less blood loss,less pain and early recovery.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第7期492-496,共5页
Chinese Journal of Spine and Spinal Cord
关键词
上颈椎
损伤
老年人
微创手术
开放手术
Upper cervical spine
Injury
Aged people
Mini-invasive surgery
Open surgery
