术中CT引导下寰枢椎复位、固定

发布时间：2018-05-19 20:35

本文选题：寰枢关节 + 寰枢关节不稳定　；参考：《北京大学学报(医学版)》2017年03期

【摘要】：目的:探讨术中CT引导下寰枢椎复位、固定手术的临床疗效。方法:选择2015年1月至8月北京大学第三医院骨科行术中CT引导下寰枢椎复位、固定术的16例患者进行回顾性分析,其中男7例,女9例,年龄26~68岁,平均49.9岁。16例中12例为陈旧性寰枢关节不稳定或脱位,4例为C2齿突新鲜骨折、脱位。16例中14例进行了寰枢椎植骨融合术,2例仅寰枢椎固定、未进行植骨。术中CT使用时机:(1)在术中置钉前CT扫描评估寰枢椎复位情况;(2)术中寰枢椎椎弓根穿刺过程中,CT扫描引导穿刺方向(其中2例患者联合使用3D打印个体化导板和术中CT引导寰枢椎置钉);(3)置钉完成后应用多平面CT重建图像评估螺钉位置及寰枢关节复位情况。计算术中CT扫描的次数,将同期实施徒手寰枢椎内固定的19例作为对照组,比较两种术式的置钉准确性。结果:本组11例术中CT扫描1次、4例2次、1例3次,平均1.4次。16例中CT扫描发现2例寰椎螺钉位置不佳,在术中进行了修正,未出现神经、血管损伤及伤口感染病例。所有病例获得随访,随访时间3~10个月,平均6.7个月。16例术后寰枢关节均获得解剖复位。术后3个月复查CT见寰枢融合良好(14例),齿突骨折骨性愈合(2例)。11例术前合并脊髓病患者脊髓功能改善,平均JOA评分由12.1分提高至14.4分。至最后一次随访均未发现断钉、断棒、内固定松动等并发症发生。置钉准确性比较,发现16例CT组所有寰枢椎螺钉位置均满意,而徒手置钉组19例中有2例4枚的螺钉位置不佳(10.5%)。结论:应用术中CT引导下寰枢椎复位、固定术提高了寰枢椎置钉的准确性,判断寰枢关节复位程度更加精确,术中即刻了解螺钉位置,一定程度上避免返修,显示该术式临床效果良好。
[Abstract]:Objective: to investigate the clinical effect of CT-guided atlantoaxial reduction and fixation. Methods: from January to August 2015, 16 cases of atlantoaxial reduction and fixation under the guidance of CT were selected and analyzed retrospectively, including 7 males and 9 females, aged 2668 years, in the Department of Orthopaedics, third Hospital of Peking University. Of the 16 cases, 12 cases were old atlantoaxial joint instability or dislocation, 4 cases were C2 odontoid fresh fracture, 14 cases of dislocation were treated with atlantoaxial fusion and 2 cases were treated with atlantoaxial fixation without bone graft. Evaluation of Atlantoaxial reduction by CT scan before Intraoperative Nail insertion. (2) CT scan guided puncture direction during atlantoaxial pedicle puncture (2 cases used 3D printing individualized guide plate and operation) The position of screw and the reduction of atlantoaxial joint were evaluated by multiplanar CT reconstruction after the insertion of atlantoaxial screw was completed. The number of CT scans during operation was calculated and 19 cases of atlantoaxial internal fixation were used as the control group to compare the accuracy of the two methods. Results: in 11 cases, CT scans were performed once, 4 cases twice and 1 case 3 times, the average time was 1.4 times. Ct scan found that 2 cases had poor position of atlas screw, and no nerve, vascular injury and wound infection were found during the operation. All cases were followed up for 3 ~ 10 months, with an average of 6.7 months. 16 cases of atlantoaxial joint were anatomically reduced. Ct examination 3 months after operation showed good atlantoaxial fusion in 14 cases, bony union of odontoid fracture in 2 cases and improvement of spinal cord function in 11 cases with myelopathy before operation. The average JOA score was increased from 12. 1 to 14. 4. To the last follow-up, there were no complications such as broken nail, broken rod and loosening of internal fixation. Compared with the accuracy of nail placement, 16 cases of CT group were found to be satisfactory in all atlantoaxial screw positions, while 2 cases of 19 cases in the bare hand nail group were found to have a poor position of 4 screws (10.5%). Conclusion: using CT to guide atlantoaxial reduction and fixation can improve the accuracy of atlantoaxial screw insertion, judge the degree of atlantoaxial joint reduction more accurately, know the position of screw immediately during operation, and avoid repairing to a certain extent. The clinical effect of this operation is good.
【作者单位】：北京大学第三医院骨科;
【基金】：首都卫生发展科研专项青年项目资助(首发2014-4-4097)~~
【分类号】：R687.3

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