成人寰椎骨折的治疗策略
[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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