摘要
目的探讨上颈椎骨折脱位并椎动脉损伤患者的围手术期处理及疗效。方法回顾性分析2008年1月至2012年12月收治的19例上颈椎骨折脱位并椎动脉损伤患者资料，男14例，女5例；年龄22～53岁，平均35．2岁。所有患者均有寰椎和（或）枢椎骨折，寰枢关系紊乱。Frankel分级：D级8例，E级11例。均采用颈后路椎弓根螺钉内固定术，椎动脉破裂出血的患者给予止血。比较术前及末次随访时的Frankel分级、日本矫形外科协会（JOA）评分、视觉模拟评分（VAS）。结果术中2例患者出现损伤侧椎动脉大出血，1例患者使用骨蜡及明胶海绵压迫止血成功，1例患者使用骨蜡及明胶海绵压迫控制出血后，行介入栓塞术治疗，止血成功，2例患者术后均未出现明显后循环缺血表现。本组患者平均手术时间为153．5min，平均失血量为542．1mL。所有患者术后获平均28个月随访，骨折均获骨性愈合，平均愈合时间13．5周。随访期间无一例患者出现缺血性脑卒中，2例出现短暂性眩晕、视物模糊等一过性脑缺血症状。末次随访时Frankel分级均为E级，JOA评分从术前平均（8．1±1．2）分提高至末次随访时（12．7±1．6）分，VAS评分从术前平均（7．0±1．7）分改善至末次随访时（1．3±1．2）分，以上指标手术前、后比较差异均有统计学意义（P〈0．05）。结论上颈椎骨折脱位患者围手术期需常规行血管成像检查，术前熟悉椎动脉及其毗邻结构，术中选择合理的止血措施，可避免术中因难以控制的大出血而影响手术进行，减少术后并发症，提高术后疗效。
Objective To explore the perioperative management and surgical outcomes of frac- ture-dislocation of the upper cervical spine complicated with vertebral artery injury. Methods We retrospectively analyzed the clinical data of 19 patients diagnosed with fracture-dislocation of the upper cervical spine complicated with vertebral artery injury who had been treated at our department from January 2008 through December 2012. They were 14 males and 5 females, aged from 22 to 53 years （mean, 35.2 years）. All the patients had fractures of the atlas and/or axis, and disordered atlanto-axial relationship as well. Ac- cording to Frankel grading system, 8 cases were Grade D and 11 Grade E. The cervical posterior fixation with pediele screws was adopted for all and hemostasis was conducted for those with bleeding from the broken vertebral artery. Their Frankel grade, Japanese Orthopedic Association （JOA） score and visual analogue scale （VAS） score were compared between preoperation and final follow-up. Results Intraoperative hemor- rhage occurred in 2 patients from the injured vertebral artery. Hemostasis was achieved through direct tam- ponade with bone wax and gelatin sponge in one and through endovascular intervention after bleeding control by direct tamponade in another. Neither of them presented with symptoms of posterior circulation ischemia after operation. The mean operation time was 153.5 min, and the mean blood loss was 542. 1 mL. All the patients were followed up for an average time of 28 months. Bony union was obtained in all after an average time of 13.5 weeks. Follow-ups revealed no ischemic stroke in this series. Symptoms of transient ischemic attack, like transient dizziness and blurred vision, appeared in 2 patients. At the final follow-up, all the patients were assessed as Frankel Grade E. Their mean JOA and VAS scores were significantly improved from 8.1 ± 1.2 and 7.0 ± 1.7 preoperatively to 12.7 ± 1.6 and 1.3 ±1.2, respectively （ P 〈 0.05） . Conclusions Angiography examination is routin
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2017年第3期219-224,共6页
Chinese Journal of Orthopaedic Trauma
关键词
颈椎
骨折
脱位
椎动脉损伤
Cervical
Fractures, bone
Dislocation
Vertebral artery injury
