摘要
目的探讨后路经椎弓根螺钉内固定术治疗横韧带断裂的临床疗效。方法对2002年9月至2014年6月,手术治疗的28例由于横韧带断裂致寰枢椎脱位患者进行回顾性分析,其中男17例,女11例;年龄4~56岁,平均31.8岁。其中急性损伤6例,陈旧性损伤22例,23例有神经功能损伤症状。X线检查显示寰齿间距（atlantodental interval,ADI）为5~12 mm,根据中日友好医院TOI分型,其中T2型24例,O型4例,T2型行后路经椎弓根螺钉内固定寰枢椎融合术,O型前路经口腔松解后一期行后路寰枢椎内固定及融合。观察患者治疗前后日本矫形外科学会（Japanese orthopaedic association,JOA）评分、寰椎平面脊髓有效空间（space available for the spinal cord,SAC）及颈椎功能障碍指数（neck disability index,NDI）的变化。结果所有患者均获随访,随访时间8~92个月,平均34.5个月。术前患者的JOA评分、SAC、NDI分别为（12.35±3.46）分、（9.84±2.32）mm、（38.34±10.23）,末次随访患者的JOA评分、SAC、NDI分别为（14.28±1.53）分、（14.73±1.84）mm、（18.24±7.13）,与术前相比均有改善,差异有统计学意义（P〈0.05）。结论后路经椎弓根螺钉内固定术是治疗横韧带断裂引起寰枢椎脱位的可靠术式。
Objective To investigate clinical effects of posterior C1-2 pedicle screw fixation for the disruption of transverse atlantal ligaments. Methods From September 2002 to June 2014, 28 cases of the disruption of transverse atlantal ligaments undergoing C1-2 pedicle screw fixation were reviewed retrospectively. There were 17 males and 11 females with the age ranging from 4 to 56 years（ mean： 31.8 years）. 6 cases were of acute injuries while the other 22 cases were old injuries. 23 cases were combined with neurological deficits. X-ray films demonstrated that the atlanto-dental intervals（ ADI） was 5-12 mm. According to TOI（ traction reduction type, T; operation reduction, O; irreducible type, I） classification, there were 24 cases of T2 and 4 cases of O. Cases of T2 underwent posterior C1-2pedicle screw fixation and fusion while cases of O underwent anterior tissue release together with posterior internal fixation and fusion. The space available for the cord（ SAC）, Japanese Orthopaedic Association（ JOA） score, and neck disability index（ NDI） before surgery were compared with those in the last follow-up. Results All the cases were followed up from 8 to 92 months（ on an average of 34.5 months）. The JOA score was（ 12.35±3.46）, SAC in atlas level was（ 9.84±2.32） mm and NDI was（ 38.34±10.23） preoperatively while in the last follow-up the JOA score was（ 14.28±1.53）, SAC in atlas level was（ 14.73±1.84） mm and NDI score was（ 18.24±7.13）, which were improved significantly with statistical significance（ P0.05）. Conclusions Posterior C1-2 pedicle screw fixation is reliable for atlantoaxial dislocation caused by the disruption of transverse atlantal ligament.
出处
《中国骨与关节杂志》
CAS
2015年第8期602-605,共4页
Chinese Journal of Bone and Joint
基金
国家自然科学基金(81173423)
关键词
颈椎
寰枢关节
脱位
骨折固定术
内
创伤和损伤
横韧带断裂
Cervical vertebrae
Atlanto-axial joint
Dislocations
Fracture fixation
internal
Wounds and injuries
Disruption of transverse ligament
