摘要
目的探讨自制后路寰椎多轴钉板治疗不稳定寰椎骨折的远期疗效。方法采用回顾性病例系列研究分析2011年1月至2013年4月西安交通大学附属红会医院收治的20例不稳定寰椎骨折患者的临床资料,其中男14例,女6例;年龄23~60岁[(42.7±8.6)岁]。患者均采用自制后路寰椎多轴钉板内固定治疗。记录手术时间、术中出血量;术后3 d通过颈椎CT扫描观察骨折复位情况;术后9个月通过颈椎正侧位X线片及CT扫描观察骨折愈合情况;术后1、2年及末次随访时采用Frankel分级评估有无迟发性脊髓损伤;比较术前,术后3个月、1年、2年及末次随访时颈椎视觉模拟评分(VAS);比较术后3个月、1年、2年及末次随访时颈椎轴向旋转活动度和屈伸活动度;观察术中和术后并发症发生情况。结果患者均获随访121~148个月[(135.0±6.8)个月]。手术时间为68~122 min[(86.0±14.1)min],术中出血量为90~400 ml[(120.0±67.9)ml]。术后3 d颈椎CT扫描示骨折复位均满意。术后9个月骨折均骨性愈合。术后1、2年及末次随访时,无迟发性脊髓损伤出现,Frankel分级均为E级。术后3个月、1年、2年及末次随访时,颈椎VAS分别为2.0(1.3,3.0)分、1.0(1.0,1.8)分、1.0(0.3,1.0)分、1.0(0.3,1.0)分,均较术前的7.0(6.0,7.8)分显著降低(P<0.05),且术后1、2年及末次随访时均较术后3个月进一步降低(P<0.05),其余时间点之间差异均无统计学意义(P>0.05)。术后1、2年及末次随访时,颈椎轴向旋转活动度分别为(103.0±8.3)°、(128.3±11.4)°、(129.8±13.6)°,均较术后3个月的(85.3±7.0)°显著提高(P<0.05),且术后2年及末次随访时均较术后1年进一步提高(P<0.05),末次随访时与术后2年差异无统计学意义(P>0.05)。术后1、2年及末次随访时,颈椎屈伸活动度分别为(65.5±4.8)°、(78.3±6.5)°、(79.3±6.9)°,均较术后3个月的(54.3±4.4)°显著提高(P<0.05),且术后2年及末次随访时均较术后1年进一步提高(P<0.05),末次随访时较术后2年差异无统计学意义(P>0.05)。术中均未出现动静脉等损伤。术后未出现切口感染或裂开,未出现长期卧床导致的肺部或泌尿系感染、压疮形成或深静脉血栓形成等并发症;长期随访未发现螺钉、寰椎板松动或断裂情况。1例患者末次随访时颈椎轻微疼痛,旋转时弹响,活动受限。结论自制后路寰椎多轴钉板治疗不稳定寰椎骨折,手术创伤小,复位满意,固定牢靠,疼痛缓解明显,能有效保留颈椎原有的活动度,并发症少,远期疗效满意。
Objective To investigate the long‑term efficacy of self‑designed posterior atlas polyaxial screw‑plate in the treatment of unstable atlas fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 20 patients with unstable atlas fracture who were admitted to Affiliated Honghui Hospital of Xi′an Jiaotong University from January 2011 to April 2013,including 14 males and 6 females,aged 23‑60 years[(42.7±8.6)years].All the patients were treated with internal fixation using self‑designed posterior atlas polyaxial screw‑plate.The operation time and intraoperative bleeding volume were recorded.The fracture reduction was evaluated by CT scan at 3 days after surgery.The bone healing was observed by X‑ray(anterior‑posterior and lateral views of the cervical spine)and CT scan at 9 months after surgery.The delayed spinal cord injuries were evaluated by Frankel grade at 1 and 2 years after surgery and at the last follow‑up.The Visual Analogue Scale(VAS)before surgery,at 3 months,1 year,2 years after surgery and at the last follow‑up were compared.The axial rotation,flexion and extension range of the cervical spine at 3 months,1 year,2 years after surgery and at the last follow‑up were compared.Intraoperative and postoperative complications were observed.Results All the patients were followed up for 121‑148 months[(135.0±6.8)months].The operation duration was 68‑122 minutes[(86.0±14.1)minutes],with the intraoperative blood loss of 90‑400 ml[(120.0±67.9)ml].The CT scan of the cervical spine at 3 days after surgery showed all satisfactory fracture reduction.Satisfactory bone reunion was observed at 9 months after surgery.All patients were scaled as Frankel grade E at 1 year,2 years and at the last follow‑up after surgery,with no delayed spinal cord injuries observed.The VAS scores of the cervical spine at 3 months,1 year,2 years after surgery and at the last follow‑up were 2.0(1.3,3.0)points,1.0(1.0,1.8)points,1.0(0.3,1.0)points and 1.0(0.3,1.0)points,which were significantly lower than that before surgery[7.0(6.0,7.8)points](P<0.05),with significantly lower scores at 1-,2-year after surgeny and at the last follow-up than at 3 months after surgery(P<0.05).There were no significant differences among the other time points(P>0.05).The axial rotation ranges of the cervical spine were(103.0±8.3)°,(128.3±11.4)°and(129.8±13.6)°at 1 year,2 years after surgery and at the last follow‑up respectively,which were significantly higher than that at 3 months after surgery[(85.3±7.0)°](P<0.05);It was further improved at 2 years after surgery and at the last follow‑up compared with that at 1 year after surgery(P<0.05),with no significant difference at the last follow‑up compared with that at 2 years after surgery(P>0.05).The flexion and extension range of the cervical spine at 1 year,2 years after surgery and at the last follow‑up were(65.5±4.8)°,(78.3±6.5)°and(79.3±6.9)°respectively,which were significantly higher than that at 3 months after surgery[(54.3±4.4)°](P<0.05);It was further improved at 2 years after surgery and at the last follow‑up compared with that at 1 year after surgery(P<0.05),with no significant difference between the last follow‑up and 2 years after surgery(P>0.05).No intraoperative injuries such as arteriovenous injury were observed.No incision infection or dehiscence occurred after surgery,with no complications caused by long‑term bed rest such as lung or urinary tract infection,pressure sore formation or deep vein thrombosis occurred.No loosening or breakage of the screw and atlas plate was observed at the long‑term follow‑up.One patient had mild cervical pain,snap during rotation,and limited range of motion at the last follow‑up.Conclusion Self‑designed posterior atlas polyaxial screw‑plate has merits including small surgical wounds,satisfactory reduction,solid fixation,obvious pain relief,effective preservation of the previous cervical motion,few complications,and satisfactory long‑term efficacy in the treatment of unstable atlas fracture.
作者
朱强
张海平
闫亮
贺宝荣
杨熙斌
姜永宏
郝定均
Zhu Qiang;Zhang Haiping;Yan Liang;He Baorong;Yang Xibin;Jiang Yonghong;Hao Dingjun(Department of Spine Surgery,First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Spine Surgery,Affiliated Honghui Hospital of Xi′an Jiaotong University,Xi′an 710054,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2024年第3期206-213,共8页
Chinese Journal of Trauma
基金
陕西省重点研发计划基金(S2023‑YF‑YBSF‑0012)。
关键词
寰枢关节
关节不稳定性
骨折固定术
内
Atlanto‑axial joint
Joint instability
Fracture fixation,internal
