经口单开门小钛板复位固定治疗寰椎前后弓骨折
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摘要
目的探讨利用单开门小钛板经口复位固定治疗寰椎前后弓骨折的临床疗效。方法 2012年11月—2015年11月,应用经口单开门小钛板复位固定术治疗寰椎前后弓骨折患者13例,其中寰椎前弓1处骨折合并后弓1处骨折6例,寰椎前弓2处骨折合并后弓1处骨折3例,寰椎前弓1处骨折合并后弓2处骨折和寰椎前弓2处骨折合并后弓2处骨折各2例。记录手术前后美国脊髓损伤协会(ASIA)分级及视觉模拟量表(VAS)评分,术后定期随访复查X线片、CT以评价寰椎骨折复位、骨折愈合和内固定情况以及寰枢椎的稳定性。结果 13例患者均顺利完成手术,术中未发生脊髓及椎动脉损伤。术前ASIA分级D级2例,E级11例,术后均为E级;VAS评分由术前的(6.2±1.8)分降低至术后的(2.0±0.8)分。随访3~24个月,X线片、CT复查示小钛板固定良好、无松动,骨折均获骨性愈合,无寰枢椎失稳、脱位发生。结论经口单开门小钛板复位固定是治疗寰椎前后弓骨折的有效方法,初步临床应用效果满意。
Objective To evaluate the outcome of transoral reduction and fixation of anterior-posterior arch fracture of atlas with an open-door mini titanium plate. Methods From November 2012 to November 2015,13 patients with anterior-posterior arch fracture of atlas,including 6 with 1 fracture at anterior arch and 1 fracture at posterior arch,3 with 2 fractures at anterior arch and 1 fracture at posterior arch,2 with 1 fracture at anterior arch and 2 fractures at posterior arch,2 with 2 fractures at anterior arch and 2 fractures at posterior arch,were treated with transoral open-door mini titanium plate reduction fixation. The American Spinal Cord Injury Association(ASIA) grades and visual analogue scale(VAS) score were recorded before and after operation. Patients were followed up and underweat roentgenograph and CT examination to estimate reduction,fixation,union of fracture and the stability of atlantoaxial segment. Results All the operations were successfully performed without neurovascular injury. ASIA grade was D in 2 cases and E in 11 cases before treatment,and after operation,ASIA grade was E in all patients. VAS score reduced from preoperative(6.2±1.8) to(2.0±0.8) after operation. The patients were followed up for 3-24 months. Solid bony union of fracture and no instrument displacement was found on roentgenograph and CT. No atlantoaxial instability or dislocation occurred. Conclusion Transoral reduction and fixation procedure with open-door mini titanium plate is an effective surgical method for treatment of anterior-posterior arch fracture of atlas with an ideal preliminary clinical effect.
Objective To evaluate the outcome of transoral reduction and fixation of anterior-posterior arch fracture of atlas with an open-door mini titanium plate. Methods From November 2012 to November 2015,13 patients with anterior-posterior arch fracture of atlas,including 6 with 1 fracture at anterior arch and 1 fracture at posterior arch,3 with 2 fractures at anterior arch and 1 fracture at posterior arch,2 with 1 fracture at anterior arch and 2 fractures at posterior arch,2 with 2 fractures at anterior arch and 2 fractures at posterior arch,were treated with transoral open-door mini titanium plate reduction fixation. The American Spinal Cord Injury Association(ASIA) grades and visual analogue scale(VAS) score were recorded before and after operation. Patients were followed up and underweat roentgenograph and CT examination to estimate reduction,fixation,union of fracture and the stability of atlantoaxial segment. Results All the operations were successfully performed without neurovascular injury. ASIA grade was D in 2 cases and E in 11 cases before treatment,and after operation,ASIA grade was E in all patients. VAS score reduced from preoperative(6.2±1.8) to(2.0±0.8) after operation. The patients were followed up for 3-24 months. Solid bony union of fracture and no instrument displacement was found on roentgenograph and CT. No atlantoaxial instability or dislocation occurred. Conclusion Transoral reduction and fixation procedure with open-door mini titanium plate is an effective surgical method for treatment of anterior-posterior arch fracture of atlas with an ideal preliminary clinical effect.
引文
[1]中国医师协会骨科医师分会,中国医师协会骨科医师分会《成人急性寰椎骨折循证临床诊疗指南》编辑委员会.成人急性寰椎骨折循证临床诊疗指南[J].中华创伤杂志,2016,32(7):595-601.
[2]陈诚,王新伟.寰椎骨折的诊断与治疗进展[J].中国脊柱脊髓杂志,2017,27(1):75-78.
[3]Mead LB 2nd,Millhouse PW,Krystal J,et al.C1fractures:a review of diagnoses,management options,and outcomes[J].Curr Rev Musculoskelet Med,2016,9(3):255-262.
[4]黄大耿,贺宝荣,郝定均,等.成人寰椎骨折的治疗策略[J].中国脊柱脊髓杂志,2017,27(5):399-405.
[5]Landells CD,Van Peteghem PK.Fractures of the atlas:classification,treatment and morbidity[J].Spine(Phila Pa 1976),1988,13(5):450-452.
[6]Huskisson EC.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[7]American Spinal Injury Association.Standards for neurological classification of spinal injury patients[M].Chicago:American Spinal Injury Association,1992.
[8]Dvorak MF,Johnson MG,Boyd M,et al.Long-term health-related quality of life outcomes following Jeffersontype burst fractures of the atlas[J].J Neurosurg Spine,2005,2(4):411-417.
[9]Horn EM,Theodore N,Feiz-Erfan I,et al.Complications of halo fixation in the elderly[J].J Neurosurg Spine,2006,5(1):46-49.
[10]尹庆水,夏虹,吴增晖,等.经口入路复位内固定治疗不稳定性Jefferson骨折[J].中国骨科临床与基础研究杂志,2012,4(6):405-410.
[11]王迎松,刘路平,张颖,等.C1,2椎弓根钉棒固定治疗寰椎骨折(Jefferson骨折)疗效分析[J].脊柱外科杂志,2010,8(1):1-3.
[12]Ruf M,Melcher R,Harms J.Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures[J].Spine(Phila Pa 1976),2004,29(7):823-827.
[13]马维虎,许楠健,徐荣明,等.经后路单纯寰椎椎弓根螺钉内固定治疗不稳定性寰椎骨折[J].脊柱外科杂志,2011,9(3):140-143.
[14]Jo KW,Park IS,Hong JT.Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct[J].J Clin Neurosci,2011,18(5):695-698.
[15]Abeloos L,De Witte O,Walsdorff M,et al.Posterior osteosynthesis of the atlas for nonconsolidated Jefferson fractures:a new surgical technique[J].Spine(Phila Pa1976),2011,36(20):E1360-1363.
[16]韩应超,杨明杰,潘杰,等.单纯寰椎侧块螺钉固定选择性治疗不稳定寰椎骨折的生物力学分析[J].中国脊柱脊髓杂志,2014,24(1):68-73.
[17]Ma XY,Yin QS,Wu ZH,et al.Anatomic considerations for the pedicle screw placement in the first cervical vertebra[J].Spine(Phila Pa 1976),2005,30(13):1519-1523.
[18]He B,Yan L,Zhao Q,et al.Self-designed posterior atlas polyaxial lateral mass screw-plate fixation for unstable atlas fracture[J].Spine J,2014,14(12):2892-2896.
[19]夏虹,林宏衡,许国庆,等.寰椎骨折前路复位内固定钢板置钉参数研究[J].中国临床解剖学杂志,2012,30(6):641-645.
[20]杨惠林,唐天驷,费仕相,等.变异型Jefferson骨折(一种尚未认识的颈椎损伤)[J].中华外科杂志,1995,33(12):707-710.
[2]陈诚,王新伟.寰椎骨折的诊断与治疗进展[J].中国脊柱脊髓杂志,2017,27(1):75-78.
[3]Mead LB 2nd,Millhouse PW,Krystal J,et al.C1fractures:a review of diagnoses,management options,and outcomes[J].Curr Rev Musculoskelet Med,2016,9(3):255-262.
[4]黄大耿,贺宝荣,郝定均,等.成人寰椎骨折的治疗策略[J].中国脊柱脊髓杂志,2017,27(5):399-405.
[5]Landells CD,Van Peteghem PK.Fractures of the atlas:classification,treatment and morbidity[J].Spine(Phila Pa 1976),1988,13(5):450-452.
[6]Huskisson EC.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[7]American Spinal Injury Association.Standards for neurological classification of spinal injury patients[M].Chicago:American Spinal Injury Association,1992.
[8]Dvorak MF,Johnson MG,Boyd M,et al.Long-term health-related quality of life outcomes following Jeffersontype burst fractures of the atlas[J].J Neurosurg Spine,2005,2(4):411-417.
[9]Horn EM,Theodore N,Feiz-Erfan I,et al.Complications of halo fixation in the elderly[J].J Neurosurg Spine,2006,5(1):46-49.
[10]尹庆水,夏虹,吴增晖,等.经口入路复位内固定治疗不稳定性Jefferson骨折[J].中国骨科临床与基础研究杂志,2012,4(6):405-410.
[11]王迎松,刘路平,张颖,等.C1,2椎弓根钉棒固定治疗寰椎骨折(Jefferson骨折)疗效分析[J].脊柱外科杂志,2010,8(1):1-3.
[12]Ruf M,Melcher R,Harms J.Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures[J].Spine(Phila Pa 1976),2004,29(7):823-827.
[13]马维虎,许楠健,徐荣明,等.经后路单纯寰椎椎弓根螺钉内固定治疗不稳定性寰椎骨折[J].脊柱外科杂志,2011,9(3):140-143.
[14]Jo KW,Park IS,Hong JT.Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct[J].J Clin Neurosci,2011,18(5):695-698.
[15]Abeloos L,De Witte O,Walsdorff M,et al.Posterior osteosynthesis of the atlas for nonconsolidated Jefferson fractures:a new surgical technique[J].Spine(Phila Pa1976),2011,36(20):E1360-1363.
[16]韩应超,杨明杰,潘杰,等.单纯寰椎侧块螺钉固定选择性治疗不稳定寰椎骨折的生物力学分析[J].中国脊柱脊髓杂志,2014,24(1):68-73.
[17]Ma XY,Yin QS,Wu ZH,et al.Anatomic considerations for the pedicle screw placement in the first cervical vertebra[J].Spine(Phila Pa 1976),2005,30(13):1519-1523.
[18]He B,Yan L,Zhao Q,et al.Self-designed posterior atlas polyaxial lateral mass screw-plate fixation for unstable atlas fracture[J].Spine J,2014,14(12):2892-2896.
[19]夏虹,林宏衡,许国庆,等.寰椎骨折前路复位内固定钢板置钉参数研究[J].中国临床解剖学杂志,2012,30(6):641-645.
[20]杨惠林,唐天驷,费仕相,等.变异型Jefferson骨折(一种尚未认识的颈椎损伤)[J].中华外科杂志,1995,33(12):707-710.