本文選題：難復(fù)性 + 寰樞椎脫位�。� 參考：《青島大學(xué)》2015年碩士論文

【摘要】：目的:本文通過對難復(fù)性寰樞椎經(jīng)前路松解復(fù)位前路內(nèi)固定與經(jīng)前路松解復(fù)位后路內(nèi)固定手術(shù)方法文獻的回顧性分析,對目前兩種主要的手術(shù)方式經(jīng)前路松解復(fù)位后路內(nèi)固定方法與經(jīng)前路松解復(fù)位前路內(nèi)固定手術(shù)方法療效及臨床價值進行評價。方法:計算機檢索(2004年至2014年)萬方、維普、中國生物醫(yī)學(xué)國內(nèi)權(quán)威數(shù)據(jù)庫以及Pumed、Springer、Sciencedirect、Wiley、Proquest、nature等國外權(quán)威數(shù)據(jù)庫,并采用手工檢索等方法收集會議文獻、文獻檢索無語種限制。對難復(fù)性寰樞椎脫位的手術(shù)治療的文獻進行收集,提取出病例數(shù)、年齡分布、病例病因分布、手術(shù)時間、術(shù)中出血量、住院時間及花費、平均隨訪時間、術(shù)前后的JOA評、延髓脊髓角、最小椎管矢狀徑數(shù)值、改善率及并發(fā)癥進行分析比較,以獲得兩種手術(shù)方法是否有差異的相關(guān)證據(jù)。結(jié)果:本研究共納入26個研究,包括386例難復(fù)性寰樞椎脫位的患者。提取的數(shù)值資料進行t檢驗,p檢驗。顯示經(jīng)前路松解復(fù)位后路內(nèi)固定與經(jīng)前路松解復(fù)位前路內(nèi)固定在病例在年齡分布、病因分布、平均隨訪時間上無明顯差別。后路內(nèi)固定較前路內(nèi)固定性別分布上差異為男性多于女性,前路松解復(fù)位前路內(nèi)固定在JOA評分改善上、手術(shù)時間及術(shù)中出血量優(yōu)于后路內(nèi)固定方法。經(jīng)前路松解后路內(nèi)固定在最小椎管矢狀徑的改善率及并發(fā)癥發(fā)病率優(yōu)于經(jīng)前路松解前路內(nèi)固定方法,兩種手術(shù)方法在延髓脊髓角的改善上無顯著的差異。結(jié)論:經(jīng)前路松解復(fù)位后路內(nèi)固定方法與經(jīng)前路松解復(fù)位前路內(nèi)固定的手術(shù)方法各有其弊端及優(yōu)勢,但都能很好的完成難復(fù)性寰樞椎的外科治療。在臨床實際治療中難復(fù)性寰樞椎的手術(shù)方法的選擇依舊依靠術(shù)前對病人的充分評估、手術(shù)者的經(jīng)驗做出選擇。
[Abstract]:Objective: to review the literature on anterior and posterior internal fixation of irreducible atlantoaxial vertebrae via anterior decompression and reduction.To evaluate the curative effect and clinical value of two main surgical methods: anterior release reduction and posterior internal fixation and anterior release reduction and anterior internal fixation.Methods: Wanfang, Weip, Chinese biomedical domestic authoritative databases and overseas authoritative databases such as Pumeda Spring Science Direction Wiley request nature were searched by computer (from 2004 to 2014). Manual retrieval was used to collect conference literature, and there was no language restriction in literature retrieval.The literatures on the surgical treatment of refractory atlantoaxial dislocation were collected, and the number of cases, age distribution, case etiological distribution, operative time, intraoperative bleeding volume, hospitalization time and cost, average follow-up time, JOA evaluation before and after operation were extracted.The minimum spinal canal sagittal diameter, improvement rate and complications were analyzed and compared in order to obtain the evidence of the difference between the two surgical methods in the medullary spinal cord angle, the minimum spinal canal sagittal diameter, the improvement rate and the complications.Results: this study included 26 studies, including 386 patients with irreducible atlantoaxial dislocation.The extracted numerical data were tested by t-test.The results showed that there was no significant difference in age distribution, etiological distribution and mean follow-up time between anterior release reduction and anterior release reduction.The gender distribution of posterior internal fixation was higher than that of anterior internal fixation. The anterior decompression and reduction of anterior internal fixation improved the JOA score. The operative time and intraoperative bleeding were better than that of posterior internal fixation.The improvement rate of the sagittal diameter of the minimal spinal canal and the incidence of complications were better than those of the anterior approach. There was no significant difference between the two surgical methods in the improvement of medullary spinal cord angle.Conclusion: the methods of anterior release reduction and posterior internal fixation have their respective disadvantages and advantages, but they can achieve the surgical treatment of irreducible atlantoaxial vertebrae.The choice of operative methods for refractory atlantoaxial vertebrae in clinical practice still depends on the full evaluation of the patients before operation and the experience of the patients.
【學(xué)位授予單位】：青島大學(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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