后路寰枢椎椎弓根螺钉内固定植骨融合治疗成人不稳定性寰椎骨折的效果

Posterior atlantoaxial pedicle screws fixation combined C1/2 fusionin adultunstable atlas fracture

中文关键词:  寰椎骨折  横韧带  寰枢椎不稳  融合内固定

英文关键词:Atlas fractures  Transverse atlantal ligament  Atlantoaxial instability  C1/2 fusion

中文摘要:

  【摘要】 目的：探讨后路寰枢椎椎弓根螺钉内固定并植骨融合治疗成人不稳定性寰椎骨折的效果。方法：对2014年1月~2018年8月我院收治的27例不稳定性寰椎骨折的患者进行回顾性研究，其中女性7例，男性20例，年龄29～78岁（54.1±10.8岁）。以横韧带断裂作为不稳定的标准，其中单纯不稳定性寰椎骨折16例，寰椎骨折合并枢椎齿状突骨折10例，合并枢椎Hangman骨折1例。致伤因素为交通伤6例，高处坠落伤20例，重物砸伤1例。均行寰枢椎椎弓根螺钉内固定并植骨融合手术，记录患者术前和术后的临床资料与影像学资料，比较术前与术后的颈部疼痛视觉模拟评分（VAS评分）、日本骨科协会（JOA）评分，随访观察骨折愈合和植骨融合情况、有无内固定物松动和/或断裂以及伤口感染等情况。结果：所有患者手术顺利，手术时间89~125min（103.7±9.3min），术中出血90~180ml（135.6±24.2ml），未出现椎动脉损伤、脊髓损伤或脑脊液漏等手术并发症。所有患者均获随访，随访时间12～30个月（21.63±4.64个月），随访期内未出现内固定物松动、断裂和伤口感染等情况，所有患者骨折均愈合，植骨均获得骨性融合。术前颈部疼痛VAS评分6.70±0.70分，术后3个月随访时为1.59±0.61分，差异有统计学意义（P<0.05）；术前JOA评分为10.85±1.11分，术后3个月随访时JOA评分为15.96±0.84分，差异有统计学意义（P<0.05）。结论：后路寰枢椎椎弓根螺钉内固定并植骨融合手术对成人不稳定性寰椎骨折能重建良好的上颈椎稳定性，可获得满意的临床疗效。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcomes of posterior atlantoaxial pedicle screws fixation combined C1/2 fusion in adult unstable atlas fracture. Methods: A retrospective study was carried out on 27 patients with unstable atlas fracture who were admitted to our hospital from January 2014 to August 2018, including 7 females and 20 males, aging from 29 to 78 years(54.1±10.8years). The integrity of the transverse atlantal ligament(TAL) was used as a stability standard. Of the 27 patients, 16 patients were of simple atlas fracture, 10 patients were of atlas fractures with odontoid fractures, and 1 patient was of atlas fracture with Hangman fracture. 20 patients were injured by falling, 6 by car accidents, and 1 by bruise. All the patients were operated with posterior atlantoaxial pedicle screws fixation combined C1/2 fusion. The preoperative and postoperative clinical data and imaging data were recorded, and the preoperative and postoperative neck pain visual analogue scores(VAS), Japanese Orthopedic Association(JOA) scores. Bone fusion, internal fixation failure and wound infection were observed in the follow-up. Results: All the patients had successful operation. The operation time was 89-125min(103.7±9.3min), and the intraoperative blood loss was 90-180ml(135.6±24.2ml). No vertebral artery injury, spinal cord injury, or cerebrospinal fluid leakage occurred. All patients were followed up for 12-30 months(21.63±4.64 months). During the follow-up, there was no internal fixation failure, or wound infection. Bone fusion was completed in all the patients. The VAS scores of neck pain were 6.70±0.70 before surgery, and decreased to 1.59±0.61 at three months after surgery(P<0.05). The JOA scores were 10.85±1.11 before surgery and increased to 15.96±0.84 at three months after surgery(P<0.05). Conclusions: Posterior atlantoaxial pedicle screws fixation combined C1/2 fusion has clinical outcomes in adult unstable atlas fracture.