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

发布时间：2018-03-30 17:14

本文选题：Jefferson骨折　切入点：不稳定　出处：《中国脊柱脊髓杂志》2017年08期

【摘要】：目的 :评估Jefferson骨折复位钢板(Jefferson fracture reduction plate,Je RP)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Je RP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Je RP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(P0.05),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(P0.05),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(P0.05)。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:Je RP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。
[Abstract]:Objective: to evaluate the results of biomechanical experiment and clinical application of Jefferson fracture reduction plate Jefferson fracture reduction plate Je RPfor unstable Jefferson fracture.Methods from May 2012 to March 2014, 6 cadavers of upper cervical vertebrae were collected from Orthopaedic Hospital of Zhengzhou City. The types of double anterior arch fractures in unstable Jefferson fractures were simulated in June 2014, and the reduction and internal fixation were performed with Je-RP internal fixation system.The horizontal loading of C0-3 segment in normal, fracture and internal fixation states (flexion, extension, left flexion, right flexion) was 20N, left rotation.Right rotation load was 2.0N m) the neutral zone and range of motion were detected and analyzed. (2) from April 2008 to January 2014, 8 patients with unstable Jefferson fracture were admitted to Guangzhou General Hospital of Guangzhou military region of Guangzhou military region, including 6 males and 2 females.The age ranged from 29 to 67 years, with an average age of 39 years, with cervical pain and limited movement, including 7 cases with no symptoms of spinal cord and nerve injury, 1 case with spinal cord injury grade D, 5 cases with atlas annulus fracture and 3 cases with unilateral anterior and posterior arch fractures.Preoperative MRI showed that 8 patients with complete transverse ligament of atlas were treated by internal fixation of Je RP through oropharynx. The fracture healing and the stability of atlantoaxial vertebra were observed by CT scan and X-ray film of cervical hyperextension and flexion.Results: there were significant differences in flexion, extension, lateral flexion and rotation between the neutral zone of fracture group and that of normal group (P 0.05). The value of three dimensional neutral zone in fracture group was significantly higher than that in normal group.There was no significant difference in the neutral area between the fixed group and the normal group in the three motor dimensions (P 0.05), but there was no significant difference between the ROM of the fixed group and the normal group in the three motor dimensions. The follow-up of 6 ~ 15 months (mean 7.2 months) was not significant in all the patients.The symptoms of occipitocervical pain and discomfort were improved in all patients. The Frankel grade was improved from grade D to grade E in one patient with spinal cord injury 6 months after operation.All the patients had good healing of the posterior wall of the oropharynx, no infection, and all the fractures were well reduced by CT, 6 months after operation, all the fractures were bony healed, no atlantoaxial instability and limited movement were found, and the initial clinical application effect was good.Conclusion the reposition and fixation of unstable Jefferson fractures by the 7% Je RP internal fixation system preserves the upper cervical movement and provides more options for the clinical treatment of unstable Jefferson fractures.
【作者单位】：郑州市骨科医院脊柱二科;广州军区广州总医院骨科医院;
【基金】：广东省重大科技专项(编号:2006A36001003-04) 国家自然科学基金面上项目(编号:30872642)
【分类号】：R687.3

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