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[1]朱耀輝,常曉盼.前路中空螺釘內(nèi)固定術(shù)與后路寰樞椎融合術(shù)治療 齒狀突骨折的對比研究[J].中醫(yī)正骨,2013,25(09):25-28.
　Zhu Yaohui*,Chang Xiaopan.*.A retrospective trial of anterior hollow screw fixation versus posterior atlantoaxial fusion for odontoid process fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(09):25-28.
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前路中空螺釘內(nèi)固定術(shù)與后路寰樞椎融合術(shù)治療 齒狀突骨折的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期數(shù):
2013年09期
頁碼:
25-28
欄目:
臨床研究
出版日期:
2013-09-30

文章信息/Info

Title:
A retrospective trial of anterior hollow screw fixation versus posterior atlantoaxial fusion for odontoid process fractures
作者:
朱耀輝; 常曉盼
河南省鄭州市骨科醫(yī)院,河南 鄭州 450052
Author(s):
Zhu Yaohui*; Chang Xiaopan.*
Orthopedic hospital of Zhengzhou,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
齒突尖 脊柱骨折 骨折固定術(shù); 內(nèi)
Keywords:
Odontoid process;  Spinal fractures;  Fracture fixation; internal
摘要:
目的:探討前路中空螺釘內(nèi)固定術(shù)與后路寰樞椎融合術(shù)治療齒狀突骨折的臨床療效及安全性。方法:回顧性分析45例齒狀 突骨折患者的臨床資料,其中采用前路中空螺釘內(nèi)固定25例,采用后路寰樞椎融合20例。比較2組患者的手術(shù)時(shí)間、術(shù)中出血量、 疼痛視覺模擬評分、骨折愈合情況及頸椎活動度,并觀察脊髓神經(jīng)功能恢復(fù)情況。結(jié)果:所有患者均獲隨訪,隨訪時(shí)間6～18個(gè)月, 中位數(shù)12個(gè)月。術(shù)后3個(gè)月,所有患者疼痛等癥狀均消失; 術(shù)后6個(gè)月,前路中空螺釘內(nèi)固定組患者骨折均獲得骨性愈合; 后路寰 樞椎融合組患者1例骨折愈合情況較差,于術(shù)后12個(gè)月隨訪時(shí)仍未完全獲得骨性愈合(P=0.000)。2組中存在神經(jīng)系統(tǒng)癥狀的患 者,Frankel脊髓損傷分級均恢復(fù)至E級。前路中空螺釘內(nèi)固定組的手術(shù)時(shí)間、術(shù)中出血量均小于后路寰樞椎融合組 [(48.0±9.7)min,(120±16.3)min,t=2.323,P=0.031;(57.0±10.6)mL,(200.0±19.5)mL,t=4.241,P=0.002] 。前路中空螺釘內(nèi)固定組的疼痛視覺模擬評分與后路寰樞椎融合組相比,差異無統(tǒng)計(jì)學(xué)意義[(2.1±0.3)分,(1.9±0.4) 分,t=0.524,P=0.635]。前路中空螺釘內(nèi)固定組的頸椎屈曲、后伸、左旋、右旋角度均大于后路寰樞椎融合組 [(40.3°±8.6°),(32.7°±7.8°),t=2.661,P=0.019];(41.4°±9.2°), (34.6°±8.5°),t=3.723,P=0.011;(75.3°±4.7°),(5.9°±0.6°),t=2.091,P=0.001; (76.1°±6.1°),(7.1°±0.7°),t=3.352,P=0.000]。結(jié)論:與后路寰樞椎融合術(shù)相比,采用前路中空螺釘內(nèi)固定術(shù)治 療齒狀突骨折,手術(shù)時(shí)間短、創(chuàng)傷小、術(shù)中出血量少、骨折愈合好、術(shù)后頸椎活動度好,值得臨床推廣應(yīng)用。
Abstract:
Objective:To explore the clinical curative effects and safety of anterior hollow screw fixation versus posterior atlantoaxial fusion in the treatment of odontoid process fractures.Methods:The clinical records of 45 patients with odontoid process fractures were analyzed retrospectively.Twenty-five patients(group A)were treated with anterior hollow screw fixation,while the others(group B)were treated with posterior atlantoaxial fusion.The two groups were compared with each other in such parameters as operative time,blood loss,visual analogue scales(VAS),fracture healing status and the range of motion(ROM)of cervical vertebrae.The recovery of spinal nerve function were also observed.Results:All the patients were available for follow-up.The median follow-up period was 12 months(range,6-18 months).Three months after surgery,the pain and other symptoms of all patients disappeared.Six months after surgery,the patients in group A got bony union.while one patient in group B had delayed union and hadn't got bony 12 months after surgery(P=0.000).The spinal function were restored (Frankel grade E)in patients with neurological symptoms in the two groups.The operative time and blood loss were less in group A compared to group B(48.0+/-9.7 vs 120+/-16.3 min,t=2.323,P=0.031; 57.0+/-10.6 vs 200.0+/- 19.5 mL,t=4.241,P=0.002).There were no statistical differences in the VAS between the two groups(2.1+/-0.3 vs 1.9+/-0.4,t=0.524,P=0.635).The angles of forward flexion,backward extension,sinistral rotation and dextral rotation of cervical vertebrae were larger in group A compare to group B(40.3+/-8.6 vs 32.7+/-7.8 degrees,t=2.661,P=0.019; 41.4+/-9.2 vs 34.6+/-8.5 degrees,t=3.723,P=0.011; 75.3+/-4.7 vs 5.9+/-0.6 degress,t=2.091,P=0.001; 76.1+/-6.1 vs 7.1+/-0.7 degrees,t=3.352,P=0.000).Conclusion:Compared with posterior atlantoaxial fusion,the therapy of anterior hollow screw fixation has such advantages as shorter operative time,less trauma,less blood loss,better fracture healing and wider postoperative range of motion of cervical vertebrae in the treatment of odontoid process fractures,so it is worth popularizing in clinic.

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備注/Memo

備注/Memo:
2012-11-26收稿 2013-03-02修回
更新日期/Last Update: 2013-09-30