经口咽前路JeRP固定与后路横向钉棒单节段固定治疗不稳定性寰椎骨折的疗效对比

Comparative study on the effect of single-segment fixation using transoral anterior JeRP and posterior horizontal screw-rod in the treatment of unstable atlas fracture

中文关键词:  寰椎骨折  不稳定性骨折  经口咽前路  后路  单节段固定  临床效果

英文关键词:Atlas fracture  Unstable fracture  Transoral anterior approach  Posterior approach  Single-segment fixation  Clinical effect

中文摘要:

  【摘要】 目的：比较经口咽前路JeRP固定与后路横向钉棒单节段固定治疗不稳定性寰椎骨折的临床效果。方法：回顾性分析2019年6月～2022年6月于我院采用单节段固定治疗的不稳定性寰椎骨折并获得随访的33例患者的临床资料，男21例，女12例，平均年龄45.1±14.3岁；其中采用经口咽前路JeRP固定治疗22例（JeRP组），采用后路横向钉棒固定治疗11例（PSR组）。两组患者的年龄、性别、病程等资料间对比均无统计学差异。对比两组的手术时间、出血量、住院时间，术前、术后出院前及末次随访时的疼痛视觉模拟评分（visual analogue scale，VAS）、颈椎功能障碍指数（neck disability index，NDI）、前弓骨折距离（distance of anterior arch fracture，DAAF）、后弓骨折距离（distance of posterior arch fracture，DPAF）、侧块分离位移（lateral mass displacement，LMD）、R-J距离[枢椎椎体下缘中点至McGregor线（硬腭后缘与枕骨大孔后下缘连线）的垂直距离]、术后并发症、术后3个月及6个月的骨折愈合率，并进行统计学分析。结果：两组病例均顺利完成手术，术中均未发生神经血管损伤等并发症。两组手术时间无差异（P>0.05），JeRP组出血量低于PSR组（P<0.05）；PSR组的住院时间较JeRP组更短（P<0.05）。两组间的术前VAS评分、NDI、DAAF、DPAF、LMD、R-J 距离均无统计学差异（P>0.05）。JeRP组的术前、术后及末次随访时的VAS评分分别为5.6±1.0分、0.9±0.8分、0.5±0.5分；PSR组分别为5.1±0.9分、0.8±0.9分、0.4±0.5分，两组术后及末次随访时的VAS评分均明显低于术前（P<0.05），组间比较无差异（P>0.05）。JeRP组的术前、术后及末次随访时的NDI分别为（58.5±3.5）%、（28.3±3.3）%、（2.0±2.7）%；PSR组分别为（57.6±3.2）%、（28.0±3.0）%、（2.2±2.1）%，两组术后及末次随访时的NDI均明显低于术前（P<0.05），组间比较无差异（P>0.05）。JeRP组的术前及术后DAAF分别为6.8±3.4mm、1.3±1.7mm；PSR组分别为7.1±2.2mm、4.4±5.3mm，两组术后DAAF均明显小于术前（P<0.05），JeRP组术后DAAF明显小于PSR组（P<0.05）。JeRP组的术前及术后DPAF分别为1.9±1.4mm、1.8±1.3mm；PSR组分别为2.2±2.0mm、0.8±1.3mm，两组术后DPAF均明显小于术前（P<0.05），JeRP组术后DPAF大于PSR组（P<0.05）。JeRP组的术前、术后及末次随访时的LMD分别为5.8±2.9mm、0.9±1.5mm、0.7±1.3mm；PSR组分别为5.6±3.7mm、3.0±3.3mm、2.7±3.6mm，两组术后及末次随访时的LMD均明显小于术前（P<0.05），JeRP组术后及末次随访时的LMD明显小于PSR组（P<0.05）。JeRP组的术前、术后及末次随访时的R-J距离分别为38.2±5.3mm、41.1±4.8mm、40.9±4.7mm；PSR组分别为37.3±3.0mm、38.6±2.3mm、38.4±2.2mm，两组术后及末次随访时的R-J距离均明显大于术前（P<0.05），JeRP组术后及末次随访时的R-J距离大于PSR组（P<0.05）。两组术后并发症发生率无显著性差异（P>0.05）。JeRP组术后3个月的骨折愈合率高于PSR组（59.1% vs 18.2%，P<0.05），但术后6个月时两组间无显著性差异（86.4% vs 63.6%，P>0.05）。结论：两种单节段固定术治疗不稳定性寰椎骨折均可获得满意的临床疗效。经口咽前路JeRP固定较后路横向钉棒固定的骨折复位及短期骨折愈合效果更佳，但住院时间较长。

英文摘要:

  【Abstract】 Objectives: To compare the clinical effects of single-segment fixations using transoral anterior JeRP and posterior horizontal screw-rod in the treatment of unstable atlas fractures. Methods: The clinical data of 33 patients with unstable atlas fractures treated with single-segment fixation in our hospital from June 2019 to June 2022 were retrospectively analyzed, including 21 males and 12 females, with an average age of 45.1±14.3 years. Among them, 22 patients were treated with transoral anterior JeRP fixation(JeRP group) and 11 patients were treated with posterior horizontal screw-rod fixation(PSR group). There was no statistical difference in age, gender, and course of disease between the two groups. The operative time, blood loss, length of hospital stay, and preoperative, before charge, and final follow-up visual analogue scale(VAS) score, neck disability index(NDI), distance of anterior arch fracture(DAAF) and distance of posterior arch fracture(DPAF), lateral mass displacement(LMD), R-J distance(the vertical distance from the midpoint of the lower margin of the axis to the McGregor line), postoperative complications, as well as fracture fusion rate 3 months and 6 months after surgery were compared between the two groups and analyzed statistically. Results: The operation was completed successfully in both groups without neurovascular injury or other complications. There was no difference in operative time between the two groups(P>0.05), but the blood loss in JeRP group was less than that in PSR group(P<0.05). The length of hospital stay in the PSR group was shorter than that in the JeRP group(P<0.05). There were no statistically significant differences in preoperative VAS score, NDI, DAAF, DPAF, LMD and R-J distance between the two groups(P>0.05). The VAS scores of the JeRP group before and after operation, and at final follow-up were 5.6±1.0, 0.9±0.8 and 0.5±0.5, respectively, while the VAS scores of the PSR group were 5.1±0.9, 0.8±0.9 and 0.4±0.5, respectively. The VAS scores after operation and at final follow-up of both groups were significantly lower than those before operation(P<0.05), and there was no difference between the two groups(P<0.05). The preoperative, postoperative and final follow-up NDI of the JeRP group were (58.5±3.5)%, (28.3±3.3)% and (2.0±2.7)%, respectively, while the NDI of the PSR group was (57.6±3.2)%, (28.0±3.0)% and (2.2±2.1)%, respectively. The NDI of the two groups after operation and at final follow-up were significantly lower than that before operation(P<0.05), and there was no difference between groups(P>0.05). The preoperative and postoperative DAAF of the JeRP group was 6.8±3.4mm and 1.3±1.7mm, respectively, while in PSR group, the values were 7.1±2.2mm and 4.4±5.3mm, respectively. Postoperative DAAF in both groups was significantly lower than that before operation(P<0.05), and postoperative DAAF in JeRP group was significantly lower than that in PSR group(P<0.05). The DPAF was 1.9±1.4mm and 1.8±1.3mm in the JeRP group before and after operation, and 2.2±2.0mm and 0.8±1.3mm in the PSR group. Postoperative DPAF in both groups was significantly lower than that before operation(P<0.05), and postoperative DPAF in JeRP group was higher than that in PSR group(P<0.05). The preoperative, postoperative and final follow-up LMD of the JERP group was 5.8±2.9mm, 0.9±1.5mm and 0.7±1.3mm, respectively, while the LMD of the PSR group was 5.6±3.7mm, 3.0±3.3mm and 2.7±3.6mm, respectively. The LMD of the two groups after operation and at final follow-up was significantly lower than that before operation(P<0.05), and the postoperative and final follow-up LMD of JeRP group was significantly lower than the PSR group(P<0.05). The R-J distance of the JeRP group before and after operation, and at final follow-up was 38.2±5.3mm, 41.1±4.8mm, 40.9±4.7mm, respectively, while that of the PSR group was 37.3±3.0mm, 38.6±2.3mm and 38.4±2.2mm, respectively. The postoperative and final follow-up R-J distance of the two groups was significantly higher than that before operation(P<0.05), the R-J distance after operation and at final follow-up in JeRP group was greater than that in PSR group(P<0.05). There was no difference in the incidence of postoperative complications between the two groups(P>0.05). The fracture fusion rate of the JeRP group was higher than that of the PSR group at 3 months after surgery(59.1% vs 18.2%, P<0.05), but there was no difference between the two groups at 6 months after surgery(86.4% vs 63.6%, P>0.05). Conclusions: The above mentioned two single-segment fixation techniques can both achieve satisfactory clinical effects in treating unstable atlas fractures. Transoral anterior JeRP fixation is better than posterior horizontal screw-rod fixation in fracture reduction and short-term fracture fusion, but the length of hospital stay is longer.