颈前路空心拉力螺钉治疗齿状突骨折

发布时间：2018-06-22 07:52

本文选题：前路 + 齿状突　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:评估应用经颈前路空心拉力螺钉固定技术在齿状突骨折治疗中的应用价值。方法:回顾性分析福建医科大学附属第一医院骨科(三级甲等医院)自2005年7月到2014年3月收治的齿状突骨折42例。II型37例,浅III型5例。其中男性25例,女性17例;年龄15-71岁,平均34±3.2岁。术中透视下行颈前路空心拉力螺钉内固定。针对研究对象的手术时间、术中失血量、术后引流量、术后并发症等进行综合分析,并随访齿状突骨折愈合情况。并就该技术在临床应用中遇到的问题进行探讨分析。结果:本组随访时间(45±9.5)个月(5~108个月)。均使用1枚空心拉力螺钉(38±1.2)mm(36~40mm)固定,手术时间(85±15.4)min(60~110min),术中出血量(30±7.5)ml(10~50ml),术后引流量(23±6.2)ml(10~50 ml),住院天数(16±3.8)天(11~21天),骨性愈合时间12~24w,平均骨折愈合时间16.5±2.5w。术前颈部不适、活动受限症状,手术后均获得了良好缓解,2例伴随明显神经症状患者术后均获得不同程度的好转。本组患者全部骨折复位,手术切口呈I级甲等愈合,无吞咽苦难、感染、呼吸困难、螺钉移位、螺钉断裂等并发症,3例患者出现喉上神经损伤症状,经对症治疗,症状基本缓解。术后随访骨折均愈合,效果满意。Frankel分级(术前、术后):II型:E级(32例、35例),D级(3例、2例),A级(2例、0例);浅III型:E级(4例、5例),D级(1例、0例)。结论:经颈前路单枚空心拉力螺钉技内固定技术具有创伤小、出血少、并发症发生率低、手术时间短、恢复快等优点,尤其能最大限度保留上颈椎生理活动功能,是一种治疗齿状突骨折的安全有效的手术方法。为避免并发症发生,术前应严格选择适应证和规范的术中精细操作。国人齿状突骨折适宜单枚螺钉固定。
[Abstract]:Objective: to evaluate the value of anterior cervical cannulated screw fixation in the treatment of odontoid fracture. Methods: from July 2005 to March 2014, 42 cases of odontoid process fractures, 37 cases of type II and 5 cases of superficial type III, were retrospectively analyzed in the Department of Orthopaedics (Grade 3A Hospital) of the first affiliated Hospital of Fujian Medical University. There were 25 males and 17 females, aged 15-71 years with an average age of 34 卤3.2 years. The internal fixation of anterior cervical hollow pull screw was performed by fluoroscopy. The operative time, blood loss, postoperative drainage and postoperative complications were analyzed, and the healing of odontoid fracture was followed up. The problems encountered in the clinical application of this technique are discussed and analyzed. Results: the follow-up time was (45 卤9.5) months (5 ~ 108 months). All patients were fixed with one hollow lag screw (38 卤1.2) mm (36~40mm), the operative time was (85 卤15.4) min (60~110min), the intraoperative bleeding volume was (30 卤7.5) ml (10~50ml), the postoperative drainage volume was (23 卤6.2) ml () 1050 ml), hospitalization days (16 卤3.8) days (1121 days), the bone healing time was 1224 weeks, the average fracture healing time was 16.5 卤2.5 ws. The symptoms of preoperative neck discomfort and limited movement were all improved in different degree after operation in 2 patients with obvious neurological symptoms. All of the patients had fracture reduction. The operative incision was grade I grade A healing, without swallowing suffering, infection, dyspnea, screw displacement, screw fracture and other complications in 3 patients with supralaryngeal nerve injury, which was treated with symptomatic treatment. The symptoms were basically relieved. All the fractures were healed after operation. The results were satisfactory. Frankel grade (before and after operation) was 30% type II grade E (32 cases, 35 cases), D grade (3 cases, 2 cases), grade A (2 cases, 0 cases), shallow type III, grade E (4 cases, 5 cases), grade D, grade D (1 case, 0 case). Conclusion: the technique of single hollow pull screw through anterior cervical approach has the advantages of less trauma, less bleeding, lower incidence of complications, shorter operation time and faster recovery, especially it can preserve the physiological function of the upper cervical spine to the maximum extent. It is a safe and effective method for the treatment of odontoid fracture. In order to avoid complications, the indication and standard fine operation should be strictly selected before operation. The fracture of odontoid process is suitable for single screw fixation in Chinese.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】