难复性寰枢椎脱位前、后路内固定的回顾性分析

发布时间：2018-04-12 06:04

本文选题：难复性 + 寰枢椎脱位　；参考：《青岛大学》2015年硕士论文

【摘要】：目的:本文通过对难复性寰枢椎经前路松解复位前路内固定与经前路松解复位后路内固定手术方法文献的回顾性分析,对目前两种主要的手术方式经前路松解复位后路内固定方法与经前路松解复位前路内固定手术方法疗效及临床价值进行评价。方法:计算机检索(2004年至2014年)万方、维普、中国生物医学国内权威数据库以及Pumed、Springer、Sciencedirect、Wiley、Proquest、nature等国外权威数据库,并采用手工检索等方法收集会议文献、文献检索无语种限制。对难复性寰枢椎脱位的手术治疗的文献进行收集,提取出病例数、年龄分布、病例病因分布、手术时间、术中出血量、住院时间及花费、平均随访时间、术前后的JOA评、延髓脊髓角、最小椎管矢状径数值、改善率及并发症进行分析比较,以获得两种手术方法是否有差异的相关证据。结果:本研究共纳入26个研究,包括386例难复性寰枢椎脱位的患者。提取的数值资料进行t检验,p检验。显示经前路松解复位后路内固定与经前路松解复位前路内固定在病例在年龄分布、病因分布、平均随访时间上无明显差别。后路内固定较前路内固定性别分布上差异为男性多于女性,前路松解复位前路内固定在JOA评分改善上、手术时间及术中出血量优于后路内固定方法。经前路松解后路内固定在最小椎管矢状径的改善率及并发症发病率优于经前路松解前路内固定方法,两种手术方法在延髓脊髓角的改善上无显著的差异。结论:经前路松解复位后路内固定方法与经前路松解复位前路内固定的手术方法各有其弊端及优势,但都能很好的完成难复性寰枢椎的外科治疗。在临床实际治疗中难复性寰枢椎的手术方法的选择依旧依靠术前对病人的充分评估、手术者的经验做出选择。
[Abstract]:Objective: to review the literature on anterior and posterior internal fixation of irreducible atlantoaxial vertebrae via anterior decompression and reduction.To evaluate the curative effect and clinical value of two main surgical methods: anterior release reduction and posterior internal fixation and anterior release reduction and anterior internal fixation.Methods: Wanfang, Weip, Chinese biomedical domestic authoritative databases and overseas authoritative databases such as Pumeda Spring Science Direction Wiley request nature were searched by computer (from 2004 to 2014). Manual retrieval was used to collect conference literature, and there was no language restriction in literature retrieval.The literatures on the surgical treatment of refractory atlantoaxial dislocation were collected, and the number of cases, age distribution, case etiological distribution, operative time, intraoperative bleeding volume, hospitalization time and cost, average follow-up time, JOA evaluation before and after operation were extracted.The minimum spinal canal sagittal diameter, improvement rate and complications were analyzed and compared in order to obtain the evidence of the difference between the two surgical methods in the medullary spinal cord angle, the minimum spinal canal sagittal diameter, the improvement rate and the complications.Results: this study included 26 studies, including 386 patients with irreducible atlantoaxial dislocation.The extracted numerical data were tested by t-test.The results showed that there was no significant difference in age distribution, etiological distribution and mean follow-up time between anterior release reduction and anterior release reduction.The gender distribution of posterior internal fixation was higher than that of anterior internal fixation. The anterior decompression and reduction of anterior internal fixation improved the JOA score. The operative time and intraoperative bleeding were better than that of posterior internal fixation.The improvement rate of the sagittal diameter of the minimal spinal canal and the incidence of complications were better than those of the anterior approach. There was no significant difference between the two surgical methods in the improvement of medullary spinal cord angle.Conclusion: the methods of anterior release reduction and posterior internal fixation have their respective disadvantages and advantages, but they can achieve the surgical treatment of irreducible atlantoaxial vertebrae.The choice of operative methods for refractory atlantoaxial vertebrae in clinical practice still depends on the full evaluation of the patients before operation and the experience of the patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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