后路单轴螺钉单节段固定治疗不稳定寰椎骨折的临床疗效

Posterior single-segmental osteosynthesis with monoaxial screw system for unstable C1 fractures

中文关键词:  寰椎骨折  不稳定  单轴螺钉固定  疗效

英文关键词:Atlas fracture  Unstable  Monoaxial screw fixation  Outcome

中文摘要:

  【摘要】 目的：评价后路单轴螺钉单节段固定治疗不稳定寰椎骨折的临床效果。方法：回顾性分析2010年1月~2019年6月在我院采用后路单轴螺钉单节段固定治疗的23例不稳定寰椎骨折患者的临床资料，其中男15例，女8例；年龄21～62岁（38.5±11.3岁）。记录手术时间、术中出血量，比较术前、术后1周及末次随访时前方和后方骨折端的距离、侧块移位距离（LMD）、颅底-齿状突间隙（BDI）、颈椎日本外科学会（JOA）评分、疼痛视觉模拟评分（VAS），观察围手术期并发症和骨折愈合情况。结果：手术均顺利完成，手术时间50～136min（93.6±28.1min），术中出血量55～223ml（158.5±53.6ml）。随访6～24个月（15.3±8.5个月），术后6～12个月均获骨性愈合。前、后方骨折端的距离术前分别为6.4±2.3mm、3.6±1.9mm，术后1周时为1.1±0.6mm、1.9±0.8mm，与术前比较均有统计学差异（P<0.05），末次随访时骨折已愈合。术前、术后1周和末次随访时的LMD、BDI、JOA评分和VAS评分分别为7.3±2.1mm、0.5±0.3mm和0.7±0.5mm，4.5±1.3mm、8.2±1.5mm和7.6±1.6mm，9.2±2.6分、14.8±1.9分和15.6±0.9分，7.2±1.8分、2.6±1.5分和1.5±1.1分，术后1周和末次随访时与术前比较均有统计学差异（P<0.05），末次随访时与术后1周比较均无统计学差异（P>0.05）。术后2例切口浅部感染，7例枕颈部不适并活动受限，均经保守治疗后痊愈。末次随访时无内固定物松动、断裂，寰椎骨折愈合良好，动力位X线片未见寰枢椎不稳。结论：后路单轴螺钉单节段固定治疗不稳定寰椎骨折可以有效复位骨折，维持枕－寰－枢复合体高度及稳定性，临床效果良好。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of posterior single-segmental osteosynthesis with monoaxial screw system for unstable C1 fractures. Methods: A retrospective case series study was conducted to analyze the clinical data of 23 patients with unstable C1 fractures admitted to Henan Provincial People′s Hospital from January 2010 to June 2019. All patients were treated with posterior single-segmental osteosynthesis with monoaxial screw system. There were 15 males and 8 females, aged 21-62 years (38.5±11.3 years). Operation time and blood loss were recorded. Distance between anterior and posterior fracture ends, lateral mass displacement(LMD), basion-dental interval (BDI), the Japanese orthopedic association (JOA) score and visual analogue scale(VAS) were compared before operation, 1 week after operation and at the last follow-up. The perioperative complications and fracture healing were recorded. Results: All the operations were completed successfully. The operation time was 50-136min(93.6±28.1min), and the operative blood loss was 55-223ml(158.5±53.6ml). The patients were followed up for 6-24 months(15.3±8.5 months). Fracture healing was achieved 6-12 months after operation. The distances between the anterior and posterior fracture ends were 6.4±2.3mm and 3.6±1.9mm before operation, and 1.1±0.6mm and 1.9±0.8mm at 1 week after operation, and the differences were significant(P<0.05). The fracture healed at the last follow-up. The LMD, BDI, the scores of JOA and the scores of VAS before operation, 1 week after operation and at the last follow-up were 7.3±2.1mm, 0.5±0.3mm and 0.7±0.5mm, 4.5±1.3mm, 8.2±1.5mm and 7.6±1.6mm, 9.2±2.6, 14.8±1.9 and 15.6±0.9, 7.2±1.8, 2.6±1.5 and 1.5±1.1 respectively. There was significant difference between that at 1 week after operation and that before operation(P<0.05), and between that at the last follow-up and that before operation(P<0.05). There was no significant difference between that at the last follow-up and that at 1 week after operation(P>0.05). There were 2 cases of superficial incision infection and 7 cases of occipitocervical discomfort and limitation of movement, which were cured after conservative treatment. At the last follow-up, there was no internal fixation loosening or fracture. The atlas fracture healed well, and atlantoaxial instability was not found on dynamic X-ray. Conclusions: Posterior single-segmental osteosynthesis with monoaxial screw system for unstable C1 fractures is able to reduce fracture effectively and maintain the height and stability of the occipital-atlantoaxial position, which has good clinical effect.