摘要
目的比较寰椎椎弓根螺钉结合枢椎椎弓根螺钉与寰椎侧块螺钉结合枢椎椎弓根螺钉治疗寰枢椎失稳的临床疗效。方法 2006年1月-2011年1月于我院行后路寰枢椎融合术患者,共纳入研究91例。分为两组：寰椎侧块螺钉组48例（采用寰椎侧块-枢椎椎弓根螺钉固定）和寰椎椎弓根螺钉组43例（采用寰椎椎弓根-枢椎椎弓根螺钉固定）。分析比较两组置钉的准确率、内固定破坏率、骨性愈合率以及手术时间、术中出血量、术后颈枕区疼痛改善情况（VAS评分）和神经功能改善情况（Frankel分级）等。结果本组随访时间24-60个月,平均40.5个月,切口均Ⅰ期愈合。两组寰枢椎间均骨性愈合,除2例枢椎椎弓根螺钉对椎动脉造成损伤外,余内固定位置均准确,未见内固定破坏。尽管寰椎侧块组有2例因静脉丛出血较多,达1 000 ml左右,但两组间术中失血量比较,差异无统计学意义（P〉0.05）。寰椎侧块螺钉组的手术时间要明显少于椎弓根螺钉组,且差异有统计学意义（P〈0.05）;两组间术前和术后末次随访时VAS评分和Frankel分级比较差异均无统计学意义（P〉0.05）,但术后较术前均明显改善,差异有统计学意义（P〈0.05）。结论 （1）寰椎侧块螺钉技术和寰椎椎弓根螺钉技术均能获得满意的临床效果,是治疗寰枢椎失稳的有效手段。（2）由于寰椎椎弓根螺钉技术勿需扩大显露范围,从而少见神经血管损伤,但对术者要求较高;而侧块螺钉技术具有操作简便、安全之优点,但存在潜在的出血和神经根刺激的风险。
Objective ＇Fo compare the clinical effect of Atlas pedicle screws combined with atlanto - axial pedicle screws and Atlas lateral mass screws combined with atlanto - axial pedicle screws for Atlanto - axial vertebral instability. Methods From Jan 2006 to Jan 2011,91 patients in our hospital were performed with posterior atlanto - axial vertebral fnsion. They were divided into two groups：Atlas lateral mass screw group 48 cases （the atlas lateral - axis of pedicle screws） and atlas pediele screw group 43 cases （the atlas pedicle - axis of pedicle screws）. Nailing accuracy,internal fixation failure rate, osseous healing rate,operation time,intraoperative blood loss,improvement of pain of postoperative neck pillow area （ VAS score） and neurological function improvement （Frankel classification） were analyzed and compared in two groups. Results All the patients were achieved primary healing of incision in the follow - up time 24 - 60 months, a mean of 40. 5 months. Both groups of atlanto - axial intervertebral achieved osseous healing and all the internal fixation position were accurate except of 2 cases of vertebral artery injury. In spite of atlas lateral group had 2 cases of venous plexus bleeding about 1 000 ml ,the intraoperative blood loss between the two groups had no signifcant difference（ P 〉0. 05）. Operation time of atlas lateral mass screw group was less than pedicle screw group, and the difference was statistically significant （ P 〈 0. 05 ）. Between the two groups, VAS scores at the time of the last follow - up and Frankel classification of preoperative and postoperative had no significant difference（ P 〉0. 05 ） , but the preoperative scores were significantly improved after surgery（ P 〈 0. 05）. Conclusions （ 1 ） Both Atlas lateral mass screw and atlas pedicle screw technology are effective methods for treatment of atlanto - axial vertebral instability and can obtain satisfactory clinical effect. （2） Because atlas pedicle screw technology do not expand th
出处
《创伤与急危重病医学》
2014年第6期333-336,共4页
Trauma and Critical Care Medicine
基金
辽宁省科技攻关基金(20112250041)
关键词
寰枢椎失稳
椎弓根螺钉
侧块螺钉
Atlanto - axial vertebral instability
pediele screw
lateral mass screw
