经口咽JeRP内固定治疗不稳定型Jefferson骨折的生物力学和初期临床研究

Biomechanical study and preliminary clinical outcome for unstable Jefferson fractures by transoral JeRP internal fixation

中文关键词:  Jefferson骨折  不稳定  寰椎  Jefferson骨折复位钢板  经口咽

英文关键词:Jefferson fracture  Atlas  Jefferson fracture reduction plate  Unstable  Transoral

中文摘要:

  【摘要】 目的：评估Jefferson骨折复位钢板（Jefferson fracture reduction plate，JeRP）内固定治疗不稳定型Jefferson骨折的生物力学实验结果及临床应用效果。方法：（1）2012年5月~2014年3月于郑州市骨科医院收集人体上颈椎尸体标本6例，2014年6月模拟不稳定型Jefferson骨折中的前弓双骨折类型，以JeRP内固定系统模拟进行复位内固定术，并以三维运动实验机对标本C0-3节段在正常、骨折、内固定3种状态的负载（前屈、后伸、左侧屈、右侧屈加载的水平方向载荷为20N，左旋转、右旋转采用的载荷为2.0N·m的力矩）六向运动中性区及运动范围（ranges of motion，ROM）进行检测及分析。（2）2008年4月~2014年1月广州军区广州总医院收治不稳定型Jefferson骨折患者8例，男6例，女2例；年龄29~67岁，平均39岁；均以颈项部疼痛、活动受限为主，其中7例无脊髓及神经损伤症状，1例合并脊髓损伤，Frankel分级为D级，寰椎环3处骨折5例，单侧前后弓骨折 3例；术前MRI均显示寰椎横韧带完整。8例均采用经口咽JeRP内固定手术治疗，术后定期随访并应用CT扫描及颈椎过伸过屈位X线片观察骨折愈合情况及评估寰枢椎稳定性。结果：骨折组中性区与正常组中性区在屈伸、侧屈、旋转3个运动维度的差异均有统计学意义（P＜0.05），骨折组的三维中性区值均明显大于正常组；固定组的中性区与正常组中性区在3个运动维度的差异均无统计学意义（P＞0.05），固定组的ROM与正常组ROM在3个运动维度的差异均无统计学意义（P>0.05）。8例患者术后随访6~15个月，平均7.2个月，所有患者术后枕颈部疼痛不适症状均获得改善，1例合并脊髓损伤的患者术后6个月Frankel分级由D级改善至E级。所有患者口咽后壁切口愈合良好，无感染发生，术后CT示骨折均达良好复位；术后6个月CT示骨折均骨性愈合，未见寰枢椎失稳及活动受限，初期临床应用效果良好。结论：JeRP内固定系统固定在实现对不稳定型Jefferson骨折复位及固定的基础上保留了上颈椎活动度，为不稳定型Jefferson骨折的临床手术治疗提供了更多选择。

英文摘要:

  【Abstract】 Objectives: To evaluate the biomechanical and preliminary clinical outcome for unstable Jefferson fractures by Jefferson fracture reduction plate(JeRP) internal fixation. Methods: (1)A total of 6 human cadaveric upper-cervical specimen were collected in Zhengzhou Orthopaedics Hospital from May 2012 to March 2014 and made into one type of unstable Jefferson fractures, and then fixed with JeRP. The ranges of motion(ROM) of C0-3 in 3 positions were measured by three-dimensional spinal motions, and the neutral zones and ROMs of every dimension in every position were analyzed. The load on the specimen was 20N in the flexion-extension and lateral-bending direction, 2.0N·m axial torque in rotation test. (2)8 patients diagnosed as unstable Jefferson fracture and operated in Guangzhou General Hospital of Guangzhou Military Command from April 2008 to January 2014 were collected, including 6 males and 2 females， with age ranging from 29 to 67 years(average, 39 years)． 5 cases of them had 3 fractures while the other 3 cases had 2 fractures in the anterior arch and posterior arch respectively. None of these patients got rupture of transverse ligament of atlas. All the 8 patients′ main presentations included neck pain and limitation of motion. 7 cases of them had neurological deficit while 1 case got spinal cord injury and were graded as grade D by Frankel grading system. All the 8 patients underwent transoral reduction and fixation surgery with JeRP. During periodic postoperative follow-up, CT and cervical hyperextension- hyperflexion X-rays were performed to observe the healing process and stability of atlantoaxial segment. Results: (1)There was significant difference between the neutral zone of upper cervical spines of fracture status and that of normal status（P<0.05）. There was no significant difference between the neutral zone of upper cervical spines of fixation status and that of normal status（P>0.05）. There was no significant difference between the ROM of upper cervical spines of fixation status and that of normal status（P>0.05）. (2)All patients had completed follow-ups of 6-15 months(average, 7.2 months)． All these patients′ neck pain got relief and the patient suffering from neurological deficit got Frankel grade improved form grade D preoperatively to grade E postoperatively. All the patients′ oral incision healed with no infection. All fractures were reduced and healed with no atlantoaxial instability or limitation of motion. The incipient clinical results were satisfactory. Conclusions: JeRP fixation can both reduce unstable Jefferson fractures anatomically and preserve the activity of upper-cervical segment. It is a valid technique for the fusion of upper cervical spine.