寰枢椎椎弓根螺钉结合横联加压环抱内固定术在不稳定性寰椎骨折治疗中的临床应用

Clinical study on atlantoaxial pedicel screw and crosslink compression for atlantoaxial fracture

中文关键词:  寰枢关节  寰椎骨折  寰枢椎不稳  骨折内固定

英文关键词:Atlantoaxial joint  Atlas fracture  Atlantoaxial instability  Internal fixation of fracture

中文摘要:

  【摘要】 目的：探讨寰枢椎椎弓根螺钉结合横联环抱加压内固定术治疗不稳定性寰椎骨折的临床效果。方法：回顾性分析2013年8月～2017年8月采用寰枢椎椎弓根螺钉结合横联加压环抱内固定术治疗的不稳定性寰椎骨折患者14例，其中男9例，女5例；年龄22～59岁，平均43.1±1.2岁。患者均有明确颈部外伤史，其中6例患者出现四肢麻木、无力等不同程度的脊髓神经损害表现。术前均行X线片、CT及三维重建、MRI等影像学检查明确诊断，术前行颅骨牵引，在全身麻醉下行后路寰枢椎椎弓根螺钉结合横联加压环抱内固定术。记录手术时间、出血量及并发症情况，JOA评分法评估患者术前及术后1年时的神经功能状态。术后1周内、3个月、半年及1年以上定期复查颈椎正侧位X线片，评估内固定位置及骨折愈合情况。结果：所有患者均顺利完成手术，术中无椎动脉、脊髓及神经根损伤发生，术中1例出现静脉丛损伤，经止血纱填塞，出血得到控制，未出现颅脑缺血症状。手术时间80～140min，平均120.3±10.5min；出血量150～310ml，平均180.5±30.5ml。术前JOA评分5～11分，平均7.3±0.5分；术后1年JOA评分13～17分，平均14.4±0.3分，改善率为76.5%～93.4%，平均（86.5±0.9）%。所有患者寰椎骨折于术后3～6个月达骨性融合，平均3.3±0.2个月，末次随访未发生螺钉移位、松动、断裂等内固定物相关并发症。结论：寰枢椎椎弓根螺钉结合横联加压环抱内固定术治疗不稳定寰椎骨折，具有骨折复位彻底、固定牢靠的特点，是治疗不稳定寰椎骨折的有效方法。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical effect of atlantoaxial vertebral pedicle screw and crosslink compression internal fixation in the treatment of atlas fracture and atlanto-axial instability. Methods: 14 patients with atlas fracture and atlantoaxial instability in our hospital from August 2013 to August 2017 were selected. There were 9 males and 5 females with an average age 43.1±1.2 years old (range, 22 to 59). All patients had a clear history of neck trauma, including traffic injury in 8 cases, high falling injury in 5 cases and head injury in 1 case. All patients with clinical manifestations, such as different degrees of back pain, neck stiffness, flexion and rotation restricted movement, in which 6 patients had different level of spinal damage such as limb numbness and weakness. All patients had preoperative imaging examination, such as X-ray, CT, three-dimensional reconstruction and MRI, skull traction also was carried out in all patients. Atlantoaxial vertebral pedicle screw and crosslink compression was performed under general anesthesia. Posterior atlantoaxial pedicle screw combined with transverse compression embracing internal fixation were performed under general anesthesia. The operation time, bleeding volume and complications were recorded, JOA score was used to evaluate the neurological function of the patients before and at 1 year after operation. Periodic review was conducted within 1 week, 3 months, 6 months and more than 1 year after operation to understand the internal fixation and fracture healing. Results: All cases got adequate fracture reduction without the damage of vertrbral artery, spinal cord and nerve root. Bleeding occurred in 1 case because of venous plexus injury and was staunched by gauze tamponade hemostasis, no symptoms of cerebral ischemia occurred. The operation time was 80-140 minutes, with an average of 120.3±10.5 minutes, and the bleeding volume was 150-310 ml, with an average of 180.5±30.5 ml. The JOA score was improved from preoperative (7.3±0.5)/(5-11) points to (14.4±0.3)/(13-17) points at one year after operation. The average improvement was (86.5±0.9)%/(76.5%-93.4%). Atlantoaxial vertebral graft got bony fusion in 3-6 months after operation, and all fractures were healed before the final follow-up without any occurrence of internal fixation loosening, broken screw or broken rod. Conclusions: The atlantoaxial vertebral pedicle screw and crosslink compression for treating atlas fracture and atlantoaxial instability has the following advantages: complete reduction of fracture and fixed firmly. It is an effective method for the treatment of atlantoaxial fracture combined with atlantoaxial instability.