本文選題：樞椎骨折　切入點(diǎn)：骨折固定術(shù)　出處：《湖北中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討復(fù)雜樞椎骨折的臨床特點(diǎn)及診斷,分析前路經(jīng)樞椎有限內(nèi)固定術(shù)(即經(jīng)C2-3鎖定鈦板內(nèi)固定或經(jīng)齒狀突空心螺釘內(nèi)固定+C2或C2-3鎖定鈦板內(nèi)固定)及應(yīng)用一期后路C1-3釘棒系統(tǒng)內(nèi)固定+C2-3椎板間植骨融合術(shù)、二期行寰椎內(nèi)固定取出術(shù)的手術(shù)方式,探討盡可能地保留寰樞關(guān)節(jié)旋轉(zhuǎn)功能的可行性,為復(fù)雜樞椎骨折的手術(shù)治療方式提供較好的選擇及新的思路。方法:利用廣州軍區(qū)武漢總醫(yī)院病例檢索系統(tǒng)及PACS影像學(xué)系統(tǒng)收集該院骨科自2005年2月至2013年1月收治復(fù)雜樞椎骨折患者的病例、影像學(xué)資料及門診隨訪資料,并進(jìn)行整理、分析。從符合復(fù)雜樞椎骨折診斷的病例中依據(jù)特定方法確定病例選擇標(biāo)準(zhǔn)和剔除標(biāo)準(zhǔn),對納入研究范圍的患者進(jìn)行定期隨訪,隨訪內(nèi)容包括患者證狀、體征及影像學(xué)資料,除去脫落病例后,確定研究的最終對象。本課題中所有患者均為新鮮骨折。骨折類型診斷主要依靠影像學(xué)資料,包括頸椎正、側(cè)位和張口位X線片、CT平掃+三維重建及MRI,本課題中所涉及的骨折類型包含:齒狀突Ⅱ型骨折合并樞椎椎體矢狀面骨折伴寰樞關(guān)節(jié)不穩(wěn)1例,齒狀突Ⅱ型骨折合并樞椎椎體冠狀面骨折伴C1-3不穩(wěn)4例,齒狀突Ⅱ型骨折合并HangmanⅡ型骨折伴C1-3不穩(wěn)2例,齒狀突Ⅱ型骨折合并HangmanⅢ型骨折伴C1-3不穩(wěn)1例,HangmanⅡ型骨折合并樞椎椎體下端水平粉碎骨折伴C1-3不穩(wěn)2例,HangmanⅡ型骨折合并樞椎椎體矢狀面骨折伴C2-3不穩(wěn)2例,HangmanⅡ型骨折合并樞椎椎體冠狀面骨折合并C2-3不穩(wěn)5例,樞椎椎體冠狀面骨折向前滑脫合并HangmanⅠ型骨折伴C1-3不穩(wěn)1例。根據(jù)樞椎骨折情況、C1-3穩(wěn)定程度及脊髓受壓方向分別予以前路齒狀突螺釘+C2前路鋼板內(nèi)固定(1例),前路齒狀突螺釘+C2-3前路椎間盤切除植骨融合鋼板內(nèi)固定(9例),C2-3前路椎間盤切除植骨融合鋼板內(nèi)固定(7例),后路C1-3釘棒系統(tǒng)內(nèi)固定+C2-3椎間植骨融合術(shù),二期行寰椎螺釘取出術(shù)(1例)。術(shù)后結(jié)合患者自身素質(zhì)情況,予以佩戴頸托或頭頸胸支具或石膏外固定保護(hù)3個(gè)月。并定期行X線片及CT檢查,觀察并記錄患者不同時(shí)期的證狀、體征,收集影像學(xué)資料檢查等,對患者頸椎活動(dòng)度及神經(jīng)功能改善情況進(jìn)行隨訪分析。結(jié)果:所有患者獲術(shù)后12-72個(gè)月(平均18.44±14.14個(gè)月)隨訪,其中,術(shù)后3月,17例患者獲骨性愈合,1例伴有齒狀突骨折患者出現(xiàn)延遲愈合,繼續(xù)行頸托固定6個(gè)月后也獲得骨性愈合。X線片及CT復(fù)查提示骨折復(fù)位良好C1-3序列恢復(fù),頸椎穩(wěn)定性良好,所有患者頸椎活動(dòng)功能恢復(fù)滿意,其中前曲33.17°±1.543°,后伸32.89°±2.026°,側(cè)屈53.26°±5.466°,旋轉(zhuǎn)118.12°±8.772°。脊髓損傷患者術(shù)后均得到不同程度改善:脊髓神經(jīng)恢復(fù)情況根據(jù)ASIA分級:12例脊髓損傷患者中有10例獲得改善,其中1例B級患者改善為D級,5例C級患者中2例改善為D級,2例改善為E級,6例D級患者中5例改善為E級,其余6例E級患者未出現(xiàn)明顯變化。結(jié)論:復(fù)雜樞椎骨折中寰樞椎功能保留的關(guān)鍵在于充分利用傷椎及其修復(fù)能力,前路經(jīng)傷椎有限內(nèi)固定療效可靠,而“先期固定非融合,二期取出內(nèi)固定”的頸椎后路手術(shù)策略很好地補(bǔ)充了前路內(nèi)固定技術(shù)的不足。對部分復(fù)雜樞椎骨折可采取有限內(nèi)固定或分期手術(shù)方法實(shí)現(xiàn)寰樞椎功能的保留
[Abstract]:Objective: To investigate the clinical characteristics and diagnosis of complicated atlantoaxial fracture, analysis of anterior atlantoaxial fixation (i.e. limited by C2-3 or by locking titanium plate internal fixation of odontoid cannulated screw fixation in +C2 or C2-3 locking titanium plate fixation) and application of posterior C1-3 pedicle screw fixation +C2-3 laminectomy with interbody fusion, two for the atlas internal fixation methods of operation, to explore as much as possible to retain the feasibility of rotation of atlantoaxial joint, provide a better choice and new ideas for the surgical treatment of complicated atlantoaxial fractures. Methods: the Wuhan General Hospita of Guangzhou Military Region case retrieval system and PACS imaging system to collect the Department of orthopedics in our hospital from February 2005 to January 2013 were complex axis fracture cases, imaging data and follow-up data, and sort out. From the analysis of complex axis fracture diagnosis cases on the basis of specific methods To determine the case selection criteria and exclusion criteria, regular follow-up of the patients included in the study, the follow-up including symptoms, signs and imaging data, remove the cases after the final to determine the object of study. In this study all patients were fresh fractures. Fracture type diagnosis mainly depends on imaging data, including cervical spine, lateral and mouth X-ray films, CT scan and 3D reconstruction and MRI, involved in this subject include: the type of fracture of odontoid fracture with atlantoaxial vertebral sagittal with atlantoaxial instability fracture in 1 cases, type II odontoid fracture combined with atlantoaxial vertebral coronal fractures with C1-3 instability 4 cases of odontoid fracture with Hangman type II fracture with C1-3 instability in 2 cases, type II odontoid fracture with Hangman type III fractures with C1-3 instability in 1 cases, Hangman type II fracture combined with atlantoaxial vertebral bone comminuted fracture with the lower level of C1-3 Stable in 2 cases, Hangman type II fracture combined with atlantoaxial vertebral sagittal fracture with C2-3 instability in 2 cases, Hangman type II fracture combined with atlantoaxial vertebral fractures with coronal C2-3 instability in 5 cases of coronal fracture, atlantoaxial vertebral spondylolisthesis and forward type Hangman fractures with C1-3 instability in 1 cases. According to the fold axis. The stability of C1-3 and spinal cord compression direction received anterior odontoid screw +C2 anterior plate internal fixation (1 cases), anterior odontoid screw +C2-3 anterior cervical discectomy and interbody fusion and plate fixation (9 cases), C2-3 anterior cervical discectomy and interbody fusion and plate fixation (7 cases), C1-3 pedicle screw rod +C2-3 system internal fixation and interbody fusion, two patients underwent removal of atlantoaxial screw (1 cases). The postoperative patients with their own quality, to wear a neck collar or chest neck brace or plaster external fixation for 3 months. And regularly underwent X-ray and CT examination, observe and record the patient Different period of symptoms, signs, imaging data collection test, follow-up analysis of cervical activity and improve the neurological function. Results: all patients were 12-72 months postoperatively (mean 18.44 + 14.14 months) follow-up, which, after March, 17 cases were healed, 1 patients with odontoid fracture patients had delayed healing, underwent cervical fixation 6 months after bone healing. X-ray and CT examination showed good fracture reduction sequence of C1-3 recovery, good cervical stability, all the features of cervical spine patients recovered, the song before the 33.17 degrees - 1.543 degrees, 32.89 degrees of flexion. 2.026 degrees, lateral flexion 53.26 degrees - 5.466 degrees rotate 118.12 degrees - 8.772 degrees. Spinal cord injury patients after operation were improved in different degrees: spinal cord nerve recovery according to ASIA classification: 12 cases of patients with spinal cord injury in 10 cases was improved, which improved 1 cases of patients with grade B grade D 5 cases of grade C, 2 cases improved to grade D, 2 cases were improved to grade E, 6 cases of D patients in 5 cases improved to grade E, the other 6 cases of grade E patients did not change significantly. Conclusion: the key to preserve the function of complex atlas atlantoaxial atlantoaxial fracture is to fully utilize the vertebral and repair ability, anterior vertebral internal fixation and the curative effect is reliable, "early fixation and non fusion, two from posterior cervical surgery strategy fixed" good complement to the anterior internal fixation technology. On the part of complicated atlantoaxial fracture can be taken to reserve a fixed or staging operation method of atlantoaxial function in Co.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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相關(guān)期刊論文 前1條

1 馬向陽;楊進(jìn)城;尹慶水;夏虹;吳增暉;章凱;王建華;艾福志;許俊杰;王智運(yùn);邱鋒;麥小紅;;后路寰樞椎釘棒固定非融合治療新鮮Ⅱ型齒狀突骨折保留寰樞椎旋轉(zhuǎn)功能的臨床初探[J];中國脊柱脊髓雜志;2013年05期

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本文編號：1583279