摘要
目的总结不稳定性寰椎骨折的治疗进展,提出存在问题并展望研究方向。方法通过查阅国内外不稳定性寰椎骨折治疗的相关文献,就寰椎骨折稳定性评价及治疗方法、手术入路以及内固定器械选择等方面进行总结分析。结果目前,临床上认为除横韧带完整的寰椎前弓单处骨折或单纯后弓骨折外的所有寰椎骨折,均为不稳定性骨折。不稳定性寰椎骨折的治疗从传统非手术治疗、融合术,逐渐发展至单节段固定治疗。非手术治疗效果欠佳,融合术牺牲了上颈椎活动度,而单节段固定不仅能复位固定骨折,同时保留了上颈椎运动功能。单节段固定手术入路分为后路及经口入路,术中采用的内固定器械也在不断改良,主要包括钉棒系统、钉板系统以及钢板系统等。结论对于不稳定性寰椎骨折,单节段固定较非手术及传统融合术更具优势,是理想的手术方式。其中,经口入路单节段固定复位寰椎前弓骨折更直接,但存在感染风险;后路单节段固定对寰椎前弓骨折的复位效果欠佳,有待进一步探究更加有效的复位方法。
Objective To summarize the progress in treatment of unstable atlas fracture,the existing problems,and the research direction.Methods Related literature at home and abroad was reviewed.The stability evaluation of atlas fracture and treatment methods were introduced,and the selection of surgical approach and fixation instruments in treatment of unstable atlas fracture were summarized and analyzed.Results At present,atlas fractures are considered as unstable fractures except single anterior arch fractures with complete transverse ligament or simple posterior arch fractures.The treatment of unstable atlas fracture has been developed from nonsurgical treatment and traditional fusion surgery to single-segment fixation.Nonsurgical treatment is less effective,while traditional fusion surgery has a disadvantage of limited the motion of the upper cervical spine.Single-segment fixation can not only restore and fix the fracture,but also preserve the upper cervical motion function.Single-segment fixation approaches include posterior and transoral approaches,and the fixation instruments are being constantly improved,mainly including screw-rod system,screw-plate system,and plate system.Conclusion For unstable atlas fracture,single-segment fixation is an ideal surgical method,and has more advantages when compared with nonsurgical treatment and traditional fusion surgery.Singlesegment fixation via transoral approach is more direct for atlas anterior arch fracture reduction,but there is a high risk of infection;and single-segment fixation via posterior approach is less effective for the reduction of atlas anterior arch fracture.Therefore,a better reduction method should be explored.
作者
邹小宝
欧阳北平
马向阳
陈育岳
葛苏
张双
倪菱
夏虹
吴增晖
ZOU Xiaobao;OUYANG Beiping;MA Xiangyang;CHEN Yuyue;GE Su;ZHANG Shuang;NI Ling;XIA Hong;WU Zenghui(The First School of Clinical Medicine,Southern Medical University,Guangzhou Guangdong,510515,P.R.China;Department of Orthopedics,General Hospital of Southern Theatre Command of Chinese PLA,Guangzhou Guangdong,510010,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第6期793-796,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
广州市科技计划项目(201803010046)。
关键词
不稳定性寰椎骨折
非手术治疗
手术治疗
单节段固定
治疗进展
Unstable atlas fracture
nonsurgical treatment
surgical treatment
single-segment fixation
treatment progress
