前路解剖复位钢板内固定治疗寰枢椎脱位的初步临床应用

中华创伤杂志 Pub Date : 2019-08-15 DOI:10.3760/CMA.J.ISSN.1001-8050.2019.08.004

Quan-jin Zang, Xijing He, Haopeng Li, Kai Cao, Ting Zhang, Jun Dong, Jiantao Liu

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引用次数: 1

摘要

目的评价前路解剖复位钢板内固定治疗寰枢椎脱位的初步临床效果。方法对西安交通大学第二附属医院2016年1月至2017年12月收治的13例寰枢椎脱位患者进行回顾性病例系列研究。共有8名男性和5名女性，年龄20-57岁，平均年龄42岁。所有患者均接受经口咽重建和寰枢椎前路解剖复位钢板内固定，其中12例为首次手术，1例为翻修手术。记录手术时间和术中出血情况。测量斜坡轴的角度，观察寰枢椎的复位和骨移植的融合。采用日本骨科协会（JOA）评分评定神经功能，计算脊髓功能改善率。并发症也被记录下来。结果所有患者随访10～30个月[（14.2±5.0）个月]，手术时间150～285分钟[（216.8±36.7）分钟]，术中失血50～130毫升[（80.5±19.7）毫升]，术前斜率轴角为（113.2±9.1）°，术后斜率轴角（145.8±6.7）°，平均增加32.6°（P<0.01），4例患者部分减少。最后一次随访时，所有患者均获得寰枢椎融合术，愈合时间为（4.6±1.1）个月，术后神经系统症状较术前有所改善。JOA评分由术前（8.7±1.7）分提高到术后（14.3±1.2）分，平均提高5.6分（P<0.01），脊髓功能平均改善率69%。除1例脑脊液漏外，术后无脊髓、神经、血管损伤或伤口感染等并发症。结论寰枢椎前路解剖复位钢板内固定可有效恢复脱位的寰枢椎关节，恢复倾斜轴角，提高骨融合率，改善神经功能。它可以作为后固定的替代或补充。关键词：阿特拉斯；Axis；错位；内部固定器；解剖钢板

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Preliminary clinical application of anterior anatomical reduction plate fixation for atlantoaxial dislocation

Objective To evaluate the preliminary clinical effect of anterior anatomical reduction plate fixation on the treatment of atlantoaxial dislocation. Methods A retrospective case series study was conducted to analyze the 13 patients with atlantoaxial dislocation admitted to the second affiliated hospital of Xi'an Jiaotong University from January 2016 to December 2017. There were eight males and five females, aged 20-57 years, with an average age of 42 years. All patients received transoropharyngeal reconstruction and atlantoaxial anterior anatomical reduction plate fixation, 12 of which underwent the surgery for the first time but one had the revision surgery. The operation time and intraoperative bleeding were recorded. The angle of the clivus axis was measured, and the reduction of the atlantoaxial spine and the fusion of bone graft were observed. The neurological function was evaluated by Japanese Orthopedic Association (JOA) score and the improvement rate of spinal cord function was calculated. The complications were also recorded. Results All patients were followed up for 10-30 months [(14.2±5.0)months]. The operation time was 150-285 minutes [(216.8±36.7)minutes]. The intraoperative blood loss was 50-130 ml [(80.5±19.7)ml]. The slope axis angle was (113.2±9.1)° before operation and (145.8±6.7)° after operation, with an average increase of 32.6° (P<0.01). Anatomical reduction was obtained in nine patients, and partial reduction in four patients. At the last follow-up, the atlantoaxial fusion was obtained in all patients, and the healing time was (4.6±1.1)months. Postoperative neurological symptoms were improved compared with those before operation. The JOA score was improved from preoperative (8.7±1.7)points to postoperative (14.3±1.2)points, with an average increase of 5.6 points (P<0.01). The average improvement rate of spinal cord function was 69%. Except for one patient with cerebrospinal fluid leakage, there were no complications such as spinal cord, nerve, blood vessel injury or wound infection after operation. Conclusions Anterior atlantoaxial anatomical reduction plate fixation can effectively restore the dislocated atlantoaxial joint, restore slope axis angle, improve bone fusion rate, and improve nerve function. It can be used as an alternative or supplement to posterior fixation. Key words: Atlas; Axis; Dislocations; Internal fixators; Anatomical plate

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来源期刊

中华创伤杂志

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发文量

11327

期刊介绍： Chinese Journal of Trauma (International Standard Serial Publication Number: ISSN 1001-8050, Domestic Uniform Serial Publication Number: CN 50-1098/R) was founded in September 1985, which is the only high-level medical professional academic journal that can comprehensively and systematically reflect the achievements and development trends of China's traumatology medicine, and has a wide academic influence in China's traumatology medicine community. It has a wide range of academic influence in China's trauma medicine. Chinese Journal of Trauma is a source journal of China Science and Technology Paper Statistics, a source journal of China Science Citation Database (CSCD), a core journal of China Comprehensive Medicine and Health Care, a source journal of China Academic Journals Comprehensive Evaluation Database (CAJCED), a full-text journal of China Journal Full-text Database (CJFD), a core academic journal of China Center for Scientific Evaluation (RCCSE), a core academic journal of China Traumatology and Traumatology Center (CTC), a core academic journal of China Traumatology Center (RCCSE). RCCSE) core academic journals; Chinese Biomedical Journal Database (CMCC), Chinese Biomedical Journal Citation Database (CBJCED), China Journal Network (CJN), China Academic Journals (CD-ROM), Chinese Academic Journals Abstracts (Chinese Edition), Chemical Abstracts of the United States (CA), Index Copernicus of Poland (IC), and Japan Institute of Science and Technology Database (JICST), World Health Organization Western Pacific Region Medical Search (WPRIM) and Russian Journal of Abstracts (ΡЖ) included journals.