寰椎新型环抱钩棒系统与钉棒系统治疗寰枢椎不稳的临床疗效比较

发布时间：2018-07-27 21:06

【摘要】：目的:通过对寰椎新型环抱钩棒系统(A组)与钉棒系统(B组)治疗寰枢椎不稳在围手术期各项指标数据及出院后随访数据的比较,初步评价寰椎新型环抱钩棒内固定系统治疗寰枢椎不稳的临床疗效。方法:随机选取2009年6月至2013年12月在郴州市第一人民医院脊柱外科诊断为寰枢椎不稳的患者,根据纳入标准选择手术病例,收集完整病例资料:分为寰枢椎新型环抱钩棒内固定系统(A组)与钉棒内固定系统(B组),两组病例各22例。两组患者均采用自体髂骨块植骨或同种异体骨植骨。观察和比较两组手术患者的术前JOA评分、Frenkel评分、手术时间、手术切口长度、术中出血量、术后切口引流量、住院天数、术后回访3个月、6个月、1年的JOA评分与植骨融合率、寰枢椎关节稳定性(测量寰齿前间隙ADI)情况。结果:无患者因手术操作致椎动脉和脊髓损伤。两组病人术后均未发生肺部、泌尿系、伤口感染,顺利出院。44例患者随访6~12个月,平均9±3个月。全部患者植骨融合。两组患者的手术时间、手术切口长度、术中出血量、术后切口引流量、住院天数比较有明显差异(P0.05),具有可比性;术前、术后JOA评分、Frenkel评分,寰枢椎关节稳定性无明显差异(P0.05);结论:与寰枢椎后路钉棒系统内固定术相比,本术式操作安全简便,患者身体恢复较快;生物力学稳定性及植骨融合率与钉棒系统无明显差异;对寰椎后弓采用钩的固定,降低了医源性血管、神经损伤的风险;故该术式在寰枢椎后路植骨融合内固定术中是一种值得推广的手术方式。
[Abstract]:Objective: to compare the perioperative data and follow-up data of atlantoaxial instability treated by a new type of clasp and rod system (group A) and screw rod system (group B) in the treatment of atlantoaxial instability. To evaluate the clinical effect of a new type of internal fixation system for the treatment of atlantoaxial instability. Methods: patients diagnosed as atlantoaxial instability by spinal surgery in the first people's Hospital of Chenzhou City from June 2009 to December 2013 were randomly selected. Complete case data were collected and divided into two groups: the atlantoaxial new type encircling hook and rod fixation system (group A) and the screw rod fixation system (group B). 22 cases were in each group. Both groups were treated with autogenous iliac bone graft or allograft bone graft. The preoperative JOA score, operative time, operative incision length, intraoperative bleeding volume, postoperative drainage volume, hospital stay, JOA score of 3 months, 6 months, and 1 year's bone graft fusion rate were observed and compared between the two groups. Stability of atlantoaxial joint (ADI measurement of anterior atlantoodontoid space). Results: no patients suffered vertebral artery and spinal cord injury due to surgical operation. There were no lung, urinary system and wound infection in both groups. The patients were followed up for 6 ~ 12 months (mean 9 卤3 months). All patients were fused with bone graft. There were significant differences between the two groups in operation time, incision length, intraoperative bleeding volume, postoperative incision drainage volume and hospitalization days (P0.05). The JOA score before and after operation was significantly different between the two groups (P < 0.05). There was no significant difference in the stability of atlantoaxial joint (P0.05). Conclusion: compared with the internal fixation of posterior atlantoaxial screw and rod system, the operation is safe and simple, and the patient's body recovers faster, the biomechanical stability and the fusion rate of bone graft are not significantly different from those of the screw and rod system. The hook fixation of posterior arch of atlas reduces the risk of iatrogenic vascular and nerve injury, so it is worth popularizing in posterior atlantoaxial bone graft fusion and internal fixation.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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