颈枕融合与后路寰枢椎融合治疗寰枢椎不稳的疗效对比研究

发布时间：2018-03-08 19:41

本文选题：寰枢关节　切入点：脊柱融合术　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察并对比颈枕融合与后路寰枢椎融合治疗寰枢椎不稳的临床疗效。方法:回顾分析我院2012年10月至2016年7月手术治疗的寰枢椎不稳患者47例,男30例,女17例,年龄16-79岁,平均54.7岁。根据固定节段不同将其分为颈枕融合(A组15例)、后路寰枢椎融合(B组32例),通过比较JOA评分改善率、颈椎屈曲、后伸和旋转活动度、颈椎融合率评估患者临床疗效。对比两组手术时间、术中出血量、术后3d引流量、住院时间之间的差异,并对结果进行统计学分析。结果:所有患者均顺利完成手术,术后获得6-48个月随访,平均21.4个月。两组病例JOA改善率、住院时间、术后3d引流量及颈椎融合率差异无统计学意义(P0.05),但在手术时间、术中出血量、术后颈椎屈曲、后伸和旋转活动度差异有统计学意义(P0.05),B组相较于A组拥有更短的手术时间,更少的术中出血量,对颈椎屈曲、后伸及旋转活动度影响最小。结论:颈枕融合及后路寰枢椎融合均能获得满意的治疗效果,但与颈枕融合相比,后路寰枢椎融合具有出血量少、手术时间短、颈椎屈伸和旋转活动度丧失少等优点,应当作为寰枢椎不稳的首选手术方式。
[Abstract]:Objective: to observe and compare the clinical effects of cervical and occipital fusion and posterior atlantoaxial fusion in the treatment of atlantoaxial instability. Methods: from October 2012 to July 2016, 47 patients with atlantoaxial instability, 30 males and 17 females, were analyzed retrospectively. The patients were divided into two groups: group A (15 cases) with cervical and occipital fusion (n = 15) and group B (n = 32) with posterior atlantoaxial fusion. The improvement rate of JOA score, cervical flexion, extension and rotation were compared. The cervical fusion rate was used to evaluate the clinical effect of the two groups. The difference of operation time, intraoperative bleeding volume, drainage flow and hospitalization time between the two groups were compared. The results were statistically analyzed. Results: all the patients successfully completed the operation. There was no significant difference in JOA improvement rate, hospitalization time, drainage flow rate and cervical fusion rate between the two groups (P 0.05), but there was no significant difference between the two groups in the operation time, intraoperative blood loss and postoperative cervical flexion. The difference of extension and rotation activity was statistically significant. Compared with group A, group B had shorter operation time, less intraoperative bleeding, and lower cervical flexion. Conclusion: both cervical and occipital fusion and posterior atlantoaxial fusion can achieve satisfactory results, but compared with occipital fusion, posterior atlantoaxial fusion has less bleeding and shorter operative time. Cervical flexion and extension and less loss of rotation should be the first choice for atlantoaxial instability.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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