成人寰椎骨折的治疗策略

发布时间：2018-11-07 11:27

【摘要】：目的 :探讨成人寰椎骨折的治疗策略。方法 :2013年5月~2015年12月我科共收治成人单纯寰椎骨折患者58例,男31例,女27例;年龄18~72岁(45.3±14.0岁)。7例稳定寰椎骨折患者采用硬颈围固定;22例不伴横韧带断裂的不稳定寰椎骨折患者,采用头颈胸支具固定20例,halo支具固定2例;29例伴横韧带断裂的不稳定寰椎骨折患者,采用后路寰枢椎内固定融合术20例,后路寰椎单椎节内固定术9例。对患者进行常规随访,记录美国脊髓损伤协会(ASIA)分级、疼痛视觉模拟评分(VAS)以及治疗相关并发症。采用CT评估骨折愈合情况和植骨融合情况,采用颈椎动力位X线片评估寰枢椎稳定性。结果:所有患者随访12~24个月(14.3±4.0个月)。随访CT示,采用硬颈围固定的7例稳定寰椎骨折及采用头颈胸支具或halo架固定的22例不伴横韧带断裂的不稳定寰椎骨折均获得骨性愈合。20例行后路寰枢椎内固定融合术的伴有横韧带断裂的不稳定寰椎骨折有18例获得骨性融合,2例未融合但内固定仍牢靠。颈椎动力位X线片示9例行后路寰椎单椎节内固定术的患者均无寰枢椎失稳征象。治疗前ASIA分级D级4例,E级54例;末次随访ASIA分级均为E级(Z=-2.000,P=0.046)。治疗前VAS评分为4~8分(6.6±1.0分),末次随访为0~2分(0.4±0.7分)(Z=-6.682,P0.001)。保守治疗者有2例枕部发生皮肤压疮;手术者术中均无神经血管损伤,术后2例发生切口感染。结论:对于稳定的寰椎骨折,采用硬颈围固定即可;对于不伴横韧带断裂的不稳定寰椎骨折,采用头颈胸支具或halo架固定可取得良好疗效;对于伴有横韧带断裂的不稳定寰椎骨折,采用后路寰枢椎内固定融合术或后路寰椎单椎节内固定术均可获得较满意的疗效。
[Abstract]:Objective: to explore the treatment strategy of adult atlantovertebral fracture. Methods: from May 2013 to December 2015, 58 adult patients with simple atlas fracture were treated, including 31 males and 27 females, aged 1872 years (45.3 卤14.0 years). In 22 cases of unstable atlantovertebral fracture without rupture of transverse ligament, 20 cases were fixed with thoracic brace and 2 cases with halo. 29 cases of unstable atlantovertebral fracture with transverse ligament rupture were treated with posterior atlantoaxial fixation fusion in 20 cases and posterior atlantoaxial single segment fixation in 9 cases. Patients were routinely followed up to record the American Spinal Cord injury Association (Asci) (ASIA) grade, pain visual analogue score (VAS), and treatment-related complications. Fracture healing and bone graft fusion were evaluated by CT and the stability of atlantoaxial vertebrae was evaluated by cervical dynamic X-ray. Results: all patients were followed up for 12 ~ 24 months (14.3 卤4.0 months). Follow-up CT showed that, Bone healing was achieved in 7 cases of stable atlantoaxial fractures and 22 cases of unstable atlantovertebral fractures without transverse ligament rupture, which were fixed with head and neck thoracic brace or halo frame. 20 cases were treated with posterior atlantoaxial fixation fusion. Bone fusion was obtained in 18 cases of unstable atlantovertebral fractures with rupture of transverse ligament. 2 cases were not fused, but internal fixation was still reliable. X-ray films of cervical dynamic position showed no atlantoaxial instability in 9 patients who underwent posterior atlantoaxial single segment fixation. There were 4 cases with ASIA grade D and 54 cases with E grade before treatment, and all of them had ASIA grade E after the last follow up (ZP0. 046). The VAS score was 4 ~ 8 (6.6 卤1. 0) before treatment and 0 ~ 2 (0. 4 卤0. 7) at the last follow-up (P 0. 001). There were 2 cases of occipital skin pressure ulcer in conservative treatment and 2 cases of incision infection. Conclusion: for the stable atlantovertebral fracture, the rigid neck fixation can be used, and for the unstable atlantovertebral fracture without transverse ligament fracture, the head and neck thoracic brace or halo frame fixation can obtain good curative effect. For unstable atlantovertebral fractures with rupture of transverse ligament, posterior atlantoaxial fixation fusion or posterior atlantoaxial single segment fixation can obtain satisfactory results.
【作者单位】：西安交通大学附属红会医院脊柱外科;
【分类号】：R687.3

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