本文選題：寰樞椎脫位 + 復位固定術�。� 參考：《南昌大學》2017年碩士論文

【摘要】：目的:分析寰樞椎脫位后路固定術的臨床研究。方法:2014年1月到2016年12月選擇在南昌大學第二附屬醫(yī)院及南昌大學附屬九江醫(yī)院診治的寰樞椎脫位患者40例作為回顧性研究對象,根據手術方法的不同分為A組與B組各20例(A組給予經枕頸融合術治療,B組給予經C1-2釘棒復位內固定術治療。)術前影像學檢查顯示,40例患者均存在不同程度的寰樞椎脫位,其中15例合并脊髓空洞,13例患者合并Arnold-Chiari畸形并脊髓空洞形成,12例合并C2、C3融合,術前頸椎MRI檢查顯示所有病例均存在脊髓受壓,術前JOA評分平均為8.3±1.5分。患者分別行枕頸融合術(后路枕骨-樞椎螺釘間撐開復位內固定術)及C1-2釘棒復位內固定技術(寰椎椎弓根螺釘內固定術),術后所有患者復查X線、頸椎三維、CT查看手術效果及樞椎螺釘的位置,并進行JOA評分,評價手術效果。為臨床枕頸融合術及寰樞椎椎弓根螺釘內固定提供解剖學依據,對臨床應用結果進行評估分析。結果:全部手術均安全完成,術中無脊髓及椎動脈損傷等嚴重并發(fā)癥。平均用時3.8小時(3~6小時),平均出血約260ml(200~500ml)。所有患者癥狀較術前明顯好轉,術后第一天JOA評分平均為12.2±1.5分,較術前明顯改善(p0.05)。術后復查X線、頸椎CT示:40例患者寰樞椎脫位均有明顯改善,MRI示頸髓壓迫大部分得到解除。全部患者隨訪2~25個月,術后平均隨訪14.1±3.7個月,末次隨訪時JOA評分平均為14.8±2.1分,較術前及術后第一天均有改善(p0.05)。隨訪期間未出現一例內固定松動斷裂現。結論:寰樞椎脫位后路固定術(頸枕融合術及C1-2釘棒復位內固定技術)在臨床上的應用具有能改善患者生活質量,改善頸椎功能,療效確切,安全可靠,值得推廣應用。
[Abstract]:Objective: to analyze the clinical study of posterior fixation of atlantoaxial dislocation. Methods: from January 2014 to December 2016, 40 patients with atlantoaxial dislocation treated in the second affiliated Hospital of Nanchang University and Jiujiang Hospital affiliated to Nanchang University were selected as the retrospective study subjects. According to the different operation methods, 20 cases in group A and 20 cases in group B were treated with occipitocervical fusion. Group B was treated with reduction and internal fixation via C1-2 nail rod. Preoperative imaging examination showed that all 40 patients had atlantoaxial dislocation in varying degrees, of which 15 were complicated with syringomyelia, 13 with Arnold-Chiari malformation, 12 with syringomyelia and C _ 2 / C _ 3 fusion. Preoperative cervical MRI examination showed spinal cord compression in all cases. The mean preoperative JOA score was 8.3 鹵1.5. Patients were treated with occipitocervical fusion (posterior occipital and axial screw open reduction and internal fixation) and C1-2 screw reduction and internal fixation (atlas pedicle screw fixation). Three-dimensional CT scan of cervical vertebrae was performed to evaluate the operative effect and the position of axial screw. JOA score was used to evaluate the effect of the operation. To provide anatomic basis for occipitocervical fusion and atlantoaxial pedicle screw fixation. Results: all the operations were performed safely without serious complications such as spinal cord and vertebral artery injury. The average time was 3.8 hours, 3 hours and 6 hours, and the average bleeding was about 260 ml / ml ~ 200 ~ 500 ml ~ (-1). The symptoms of all patients were obviously improved compared with those before operation. The average JOA score on the first day after operation was 12.2 鹵1.5, which was significantly better than that before operation (P 0.05). All the 40 cases of atlantoaxial dislocation were obviously improved by CT and MRI showed that cervical spinal cord compression was mostly relieved. All the patients were followed up for 2 to 25 months, the average follow-up was 14.1 鹵3.7 months, and the average JOA score at the last follow-up was 14.8 鹵2.1, which was better than that before and on the first day after operation. During the follow-up period, there was no case of internal fixation loosening and fracture. Conclusion: the posterior fixation of atlantoaxial dislocation (cervical and occipital fusion and C1-2 screw rod reduction and internal fixation) can improve the quality of life of patients and improve the cervical vertebra function. The curative effect is accurate, safe and reliable, and it is worth popularizing.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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