后路寰枢椎经关节螺钉结合寰椎椎板钩与寰枢椎椎弓根螺钉固定融合治疗寰枢椎脱位的疗效比较

发布时间：2018-06-14 22:45

本文选题：寰枢椎脱位 + 可复性　；参考：《中国脊柱脊髓杂志》2017年01期

【摘要】：目的:比较后路寰枢椎经关节螺钉结合寰枢椎板钩固定融合与寰枢椎椎弓根螺钉固定融合治疗可复性寰枢椎脱位的临床疗效。方法:回顾性分析2006年6月~2012年3月行寰枢椎经关节螺钉结合寰椎椎板钩固定融合治疗的74例可复性寰枢椎脱位患者(钉钩组)的临床资料,以同时期相同纳入标准采用后路寰枢椎椎弓根螺钉固定融合治疗的63例患者(钉棒组)作为对照。记录术前疼痛视觉模拟量表(VAS)评分、脊髓功能(ASIA分级)、颈部僵硬度、颈椎功能障碍指数(NDI)、术中出血量、手术时间。以末次随访时植骨融合率、VAS评分、ASIA分级、NDI、颈部僵硬度及患者满意度评价治疗效果,并比较两组间的临床疗效。结果:两组患者的年龄、性别比和术前VAS评分、NDI、ASIA分级差异均无统计学意义(P0.05),具有可比性。钉钩组随访时间为76.3±14.0(48~110)个月,平均手术时间为126.1±8.6min,平均术中出血量为207.8±34.2ml,植骨融合率为100%,平均融合时间为4.6±0.9个月;钉棒组随访时间为72.0±12.0(48~96)个月、平均手术时间为129.8±7.9min,平均术中出血量为225.8±30.0ml,植骨融合率为98%,平均融合时间为4.8±1.2个月。两组随访时间、手术时间、植骨融合率和融合时间的差异均无统计学意义(P0.05),钉钩组的平均术中出血量与钉棒组比较差异有统计学意义(P0.05)。两组患者末次随访时VAS评分、NDI和颈部僵硬度均较术前降低(P0.05)。有神经症状的患者,钉钩组的49例与钉棒组的37例末次随访时ASIA分级较术前提高1~2级。末次随访时,VAS评分、ASIA分级、颈部僵硬度、患者满意度及NDI两组间差异均无统计学意义(P0.05)。结论:后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合与寰枢椎椎弓根螺钉固定融合治疗可复性寰枢椎脱位均能达到满意的临床疗效,但前者术中出血量更少。
[Abstract]:Objective: to compare the clinical effect of posterior transarticular screw fixation combined with atlantoaxial plate hook fixation and atlantoaxial pedicle screw fixation in the treatment of atlantoaxial dislocation. Methods: the clinical data of 74 cases of atlantoaxial dislocation treated by transarticular screw fixation and laminar hook fixation from June 2006 to March 2012 were retrospectively analyzed. Sixty-three patients with posterior atlantoaxial pedicle screw fixation were used as control group. The preoperative pain visual analogue scale (VASS) score, spinal cord function and Asia grade, cervical stiffness, cervical spine dysfunction index (NDI), intraoperative bleeding volume and operation time were recorded. The treatment effect was evaluated by VAS score and Asia grade NDI, neck stiffness and patient satisfaction at the last follow-up, and the clinical efficacy was compared between the two groups. Results: there was no significant difference in age, sex ratio and VAS score before operation between the two groups (P 0.05). In the nail hook group, the follow-up time was 76.3 卤14.0 48,110 months, the average operative time was 126.1 卤8.6 min, the average intraoperative bleeding was 207.8 卤34.2 ml, the fusion rate of bone graft was 100 and the mean fusion time was 4.6 卤0.9 months, the follow-up time of the nail and rod group was 72.0 卤12.0 and 4896 months. The mean operative time was 129.8 卤7.9 min, the average intraoperative bleeding was 225.8 卤30.0ml, the fusion rate of bone graft was 98 and the mean fusion time was 4.8 卤1.2 months. There was no significant difference in follow-up time, operation time, bone graft fusion rate and fusion time between the two groups (P 0.05). The average intraoperative blood loss in the nail hook group was significantly different from that in the nail rod group (P 0.05). At the last follow-up, the VAS score, NDI and neck stiffness in both groups were lower than those before operation (P 0.05). Among the patients with neurological symptoms, 49 cases in the nail hook group and 37 cases in the nail rod group had improved Asia grade by 1 and 2 grades at the last follow-up. At the last follow-up, there was no significant difference in Asia grade, neck stiffness, patient satisfaction and NDI between the two groups (P 0.05). Conclusion: posterior transarticular screw fixation combined with atlantoaxial laminar hook fixation fusion and atlantoaxial pedicle screw fixation fusion can achieve satisfactory clinical effect in the treatment of atlantoaxial dislocation, but the former has less intraoperative bleeding.
【作者单位】：第二军医大学附属长征医院脊柱外科;
【分类号】：R681.5;;R687.3

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