摘要
目的探讨经后路寰枢椎椎弓根钉内固定治疗寰枢椎不稳的临床疗效。方法应用经后路寰枢椎椎弓根钉内固定技术治疗寰枢椎不稳患者21例,采用视觉模拟评分法(VAS)评定术前疼痛及术后缓解程度;采用Frankel分级对术前脊髓损伤及术后恢复情况进行评定;采用日本骨科协会(JOA)评分对功能恢复情况进行评定。结果术后平均随访时间20个月,平均手术时间150 min,平均术中出血量380 ml,术后患者颈部疼痛均明显缓解,VAS评分从术前平均5.6分下降至末次随访时1.8分;术后患者脊髓损伤均不同程度恢复;JOA评分从术前平均8.8分升至末次随访时14.5分;术后发现2枚寰椎螺钉突破椎弓根内侧皮质,另2枚螺钉突破横突孔内缘,均未发生脊髓及椎动脉受损的相应症状;术后6个月所有患者均融合成功。结论经后路寰枢椎椎弓根钉内固定是治疗寰枢椎不稳的一种有效内固定方式,具有良好的生物力学稳定性,其固定节段短、术中复位、融合率高。
Objective To investigate clinical effect by posterior approach atlantoaxial pedicle screw internal fixation in the treatment of aflantoaxial instability. Methods A total of 21 atlantoaxial instability patients received posterior approach atlantoaxial pediele screw internal fixation for treatment, and their preoperative pain and postoperative relief degree were evaluated by visual analogue scale （VAS）. Preoperative spinal eord injury and postoperative recovery were evaluated by Frankel staging. Japanese orthopaedic association （JOA） was applied to evaluate function rehabilitation. Results Mean follow-up time after operation was 20 months, mean operation time was 150 min, and mean intraoperative bleeding volume was 380 ml. All patients had obviously relieved neck pain after operation, and their VAS score decreased from 5.6 points before operation to 1.8 points at the end of followup. They also had different degree of rehabilitation of spinal cord injury after operation, with decreased JOA score from 8.8 points to 14.5 points. There were 2 atlas screws breaking pedicte medial cortex and 2 screws breaking inner edge of transverse foramen. No symptom of spinal cord and vertebral artery damage was shown, and all patients had suecessfid fusion in 6 months after operation. Conclusion Posterior approach adantoaxial pedicle screw internal fixation is an effective method in treating aflantoaxial instability, mad this method contains good biomechanieal stability, along with short fixation segment, and high rates of intraoperative restoration and fusion rate.
出处
《中国现代药物应用》
2016年第13期14-16,共3页
Chinese Journal of Modern Drug Application
关键词
寰椎
枢椎
椎弓根钉
寰枢椎不稳
脊柱融合
Atlas
Axis
Pedicle screw
Atlantoaxial instability
Spinal fusion
