摘要
目的探讨3D显微镜下椎弓根螺钉内固定治疗上颈椎骨折脱位的临床疗效与安全性。方法回顾性分析2015年1月至2020年6月我院收治的36例上颈椎骨折脱位患者,15例患者采用3D显微镜下椎弓根螺钉内固定治疗(3D组),21例患者采用普通显微镜下椎弓根螺钉内固定治疗(普通组),对比两组患者的围手术期指标、临床疗效指标及安全性指标。结果3D组手术时间(162.33±34.79)min,普通组手术时间(187.59±29.45)min,3D组手术时间显著低于普通组(P<0.05),两组其他围手术期指标比较差异无统计学意义(P>0.05)。术后所有患者颈部疼痛症状均明显缓解,神经症状得到不同程度恢复,两组患者术前与术后1年VAS评分与JOA评分比较差异均有统计学意义(P<0.01),组间比较差异均无统计学意义(P>0.05)。3D组共置入上颈椎椎弓根螺钉68枚,其中0级与Ⅰ级置钉共62枚,置钉优良率91.18%,普通组共置入上颈椎椎弓根螺钉96枚,其中0级与Ⅰ级置钉共84枚,置钉优良率87.50%,两组置钉优良率比较差异无统计学意义(P>0.05);两组患者均未出现神经损伤、硬膜破裂、椎动脉损伤等并发症,3D组手术并发症发生率为13.33%,普通组手术并发症发生率为23.81%,两组并发症发生率差异无统计学意义(P>0.05)。结论3D显微镜与普通显微镜下椎弓根螺钉内固定治疗上颈椎骨折脱位均疗效确切,但3D显微镜下手术时间更短,并发症发生率可能更低。
Objective To investigate the clinical efficacy and safety of 3D microscopy-assisted posterior pedicle screw fixation in the treatment of atlantoaxial fracture and dislocation.Methods 36 patients with upper cervical fracture and dislocation who had treated in our hospital from January 2015 to June 2020 were analyzed retrospectively.15 patients received pedicle screw fixation assisted by 3D microscopy(3D group),and 21 received pedicle screw fixation assisted by ordinary microscopy(OM group).The indexes of perioperative period,clinical efficacy and safety were compared between the two groups.Results The surgical duration was(162.33 tioncy and in the 3D group and(187.59±29.45)min in the OM group,and it was significantly shorter in the 3D group than in the OM group(P<0.05).There were no significant differences in other perioperative indexes between the two groups(P>0.05).After operation,the neck pain was significantly relieved in all the patients and the neurological symptoms were alleviated at varying degrees(P<0.01).There were significant differences in the scores on VAS and JOA between the preoperative baselines and postoperative year one,but there was no significant difference between the two groups(P>0.05).A total of 68 upper cervical pedicle screws were placed in the 3D group,62 of which were in grades 0 andⅠ,with a satisfactory rate of 91.18%.In the OM group,there were 96 upper cervical pedicle screws,84 of which were in grades 0 andⅠ,with a satisfactory rate of 87.50%.There was no significant difference in the satisfactory rate between the two groups(P>0.05).No complications such as nerve injury,dural rupture,and vertebral artery injury were found in both groups.The incidence of surgery-related complications was13.33%in the 3D group and 23.81%in the OM group.There was no statistical difference in the incidence of complications between the two groups(P>0.05).Conclusions Both 3D and ordinary microscopy-assisted pedicle screw fixation are effective and safe in the treatment of upper cervical fracture and dis
作者
吴刚
丰瑞兵
胡昊
黄一拯
李超
张海涛
李朝文
黄勇
WU Gang;FENG Ruibing;HU Hao;HANG Yizheng;LI Chao;ZHANG Haitao;LI Chaowen;HUANG Yong(Department of Spinal Surgery,Hubei Hospital of TCM,Wuhan 430074,China)
出处
《实用医学杂志》
CAS
北大核心
2022年第14期1782-1787,共6页
The Journal of Practical Medicine
基金
湖北省卫生健康委员会项目(编号:WJ2021M182)。
关键词
3D显微镜
椎弓根螺钉
上颈椎
骨折
脱位
3D microscope
pedicle screw
atlantoaxial
fracture
dislocation
