摘要
目的探讨T01分型对创伤性T型寰枢椎脱位（AAD）治疗的指导作用。方法采用回顾性病例系列研究分析2012年1月-2015年12月收治的创伤性T型寰枢椎脱位患者32例，其中男19例，女13例；年龄（38．4±14．7）岁。T01分型：T1型15例，采用外固定治疗或非融合内固定治疗；T2型17例，采用融合内固定治疗。观察患者寰齿前间距（ADI）、脊髓有效空间（SAC）、寰枢关节活动度、Symon和Lavender脊髓功能分级、日本骨科学会（JOA）脊髓功能评分及颈肩部疼痛视觉模拟评分（VAS）。结果患者随访6～54个月，平均32．4个月。术前ADI为（5．6±1．6）mm，末次随访时为（2．3±1．4）mm（P〈0．01）。术前SAC为（12．0±2．9）mm，末次随访时为（15．4±1．9）mm（P〈0．01）。末次随访时，T1型患者颈椎旋转活动度为102°-154°，寰枢关节活动度恢复正常；T2型为57°～93°，寰枢关节活动度丧失。按照Symon和Lavender脊髓功能分级，患者术前轻度14例，中度9例，重度8例，特重度1例；末次随访时轻度21例，中度9例，重度2例（P〈0．05）。患者术前颈椎JOA评分为（9．9±3．2）分，末次随访时提高至（14．6±2．9）分（P〈0．01）。患者术前颈肩部疼痛VAS为（6．0±1．6）分，末次随访时降低为（2．7±1．3）分（P〈0．01）。结论根据TOI外科分型，选择合适的手术方法治疗创伤性T型寰枢椎脱位可达到重建稳定、提高神经功能的效果。对T1型寰枢椎脱位采用非融合固定治疗，可保留寰枢关节的活动度，对临床具有一定参考价值。
Objective To investigate the guidance value of TOI classification in treating traumatic T-type atlantoaxial dislocation （ADD）. Methods A retrospective case series study was made on 32 cases of traumatic TOI T-type ADD treated between January 2012 and December 2015. There were 19 males and 13 females, aged （38.4 ± 14.7 ）years. Fifteen cases of Tl-type underwent external fixation or internal fixation without fusion, while 17 cases of T2-type underwent internal fixation with fusion. Symon-Lavender clinical standard, Japanese orthopedic association score （JOA） , visual analogue scale （VAS）, atlas-dens interval （ADI） and space available for the cord （SAC） were used to evaluate the therapeutic effect. Results Patients were followed up for 6-54 months （mean, 32.4 months）. At final follow-up, ADI was decreased to （2.3 ± 1.4）mm from preoperative （5.6 ± 1.6）nma, but SAC was increased to （ 15.4 ± 1.9） mm from preoperative （ 12.0 ± 2.9） mm（ P 〈 0.01 ）. At final follow-up, cervical axial rotation range of motion was 102°-154° in Tl-type cases and 57°- 93° in T2-type cases. Range of motion for atlantoaxial joint was preserved in T1-type cases, but lost in T2-type cases. According to the Symon- Lavender clinical standard, there were 14 cases of mild disability, nine moderate disability, eight severe disability and one extremely severe disability before operation; there were 21 cases of mild disability, nine moderate disability and two severe disability at last follow-up. Significant difference was observed in the grades according to the Symon-Lavender clinical standard before operation and at last follow-up （ P 〈 0.05 ）. At last follow-up, JOA score was increased to （ 14.6 ± 2.9 ） points from preoperative （ 9.9 ± 3.2） points, and VAS was decreased to （2.7 ± 1.3 ） points from preoperative （ 6.0 ± 1.6） points （ P 〈 0.01 ）. Conclusions By using TOI classification, reconstruction of stability and improved neurological function can be achieved
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2017年第5期436-440,共5页
Chinese Journal of Trauma
关键词
寰枢关节
脱位
分型
Atlanto-axial joint
Dislocations
Classification
