寰枢椎脱位后路减压复位固定手术前后解剖及症状学的临床研究

发布时间：2018-05-07 23:21

本文选题：寰枢椎脱位 + 复位固定术　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:分析寰枢椎脱位后路固定术的临床研究。方法:2014年1月到2016年12月选择在南昌大学第二附属医院及南昌大学附属九江医院诊治的寰枢椎脱位患者40例作为回顾性研究对象,根据手术方法的不同分为A组与B组各20例(A组给予经枕颈融合术治疗,B组给予经C1-2钉棒复位内固定术治疗。)术前影像学检查显示,40例患者均存在不同程度的寰枢椎脱位,其中15例合并脊髓空洞,13例患者合并Arnold-Chiari畸形并脊髓空洞形成,12例合并C2、C3融合,术前颈椎MRI检查显示所有病例均存在脊髓受压,术前JOA评分平均为8.3±1.5分。患者分别行枕颈融合术(后路枕骨-枢椎螺钉间撑开复位内固定术)及C1-2钉棒复位内固定技术(寰椎椎弓根螺钉内固定术),术后所有患者复查X线、颈椎三维、CT查看手术效果及枢椎螺钉的位置,并进行JOA评分,评价手术效果。为临床枕颈融合术及寰枢椎椎弓根螺钉内固定提供解剖学依据,对临床应用结果进行评估分析。结果:全部手术均安全完成,术中无脊髓及椎动脉损伤等严重并发症。平均用时3.8小时(3~6小时),平均出血约260ml(200~500ml)。所有患者症状较术前明显好转,术后第一天JOA评分平均为12.2±1.5分,较术前明显改善(p0.05)。术后复查X线、颈椎CT示:40例患者寰枢椎脱位均有明显改善,MRI示颈髓压迫大部分得到解除。全部患者随访2~25个月,术后平均随访14.1±3.7个月,末次随访时JOA评分平均为14.8±2.1分,较术前及术后第一天均有改善(p0.05)。随访期间未出现一例内固定松动断裂现。结论:寰枢椎脱位后路固定术(颈枕融合术及C1-2钉棒复位内固定技术)在临床上的应用具有能改善患者生活质量,改善颈椎功能,疗效确切,安全可靠,值得推广应用。
[Abstract]:Objective: to analyze the clinical study of posterior fixation of atlantoaxial dislocation. Methods: from January 2014 to December 2016, 40 patients with atlantoaxial dislocation treated in the second affiliated Hospital of Nanchang University and Jiujiang Hospital affiliated to Nanchang University were selected as the retrospective study subjects. According to the different operation methods, 20 cases in group A and 20 cases in group B were treated with occipitocervical fusion. Group B was treated with reduction and internal fixation via C1-2 nail rod. Preoperative imaging examination showed that all 40 patients had atlantoaxial dislocation in varying degrees, of which 15 were complicated with syringomyelia, 13 with Arnold-Chiari malformation, 12 with syringomyelia and C _ 2 / C _ 3 fusion. Preoperative cervical MRI examination showed spinal cord compression in all cases. The mean preoperative JOA score was 8.3 卤1.5. Patients were treated with occipitocervical fusion (posterior occipital and axial screw open reduction and internal fixation) and C1-2 screw reduction and internal fixation (atlas pedicle screw fixation). Three-dimensional CT scan of cervical vertebrae was performed to evaluate the operative effect and the position of axial screw. JOA score was used to evaluate the effect of the operation. To provide anatomic basis for occipitocervical fusion and atlantoaxial pedicle screw fixation. Results: all the operations were performed safely without serious complications such as spinal cord and vertebral artery injury. The average time was 3.8 hours, 3 hours and 6 hours, and the average bleeding was about 260 ml / ml ~ 200 ~ 500 ml ~ (-1). The symptoms of all patients were obviously improved compared with those before operation. The average JOA score on the first day after operation was 12.2 卤1.5, which was significantly better than that before operation (P 0.05). All the 40 cases of atlantoaxial dislocation were obviously improved by CT and MRI showed that cervical spinal cord compression was mostly relieved. All the patients were followed up for 2 to 25 months, the average follow-up was 14.1 卤3.7 months, and the average JOA score at the last follow-up was 14.8 卤2.1, which was better than that before and on the first day after operation. During the follow-up period, there was no case of internal fixation loosening and fracture. Conclusion: the posterior fixation of atlantoaxial dislocation (cervical and occipital fusion and C1-2 screw rod reduction and internal fixation) can improve the quality of life of patients and improve the cervical vertebra function. The curative effect is accurate, safe and reliable, and it is worth popularizing.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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