本文選題：寰樞椎脫位 + 復(fù)位固定術(shù)　； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:分析寰樞椎脫位后路固定術(shù)的臨床研究。方法:2014年1月到2016年12月選擇在南昌大學(xué)第二附屬醫(yī)院及南昌大學(xué)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(jù)手術(shù)方法的不同分為A組與B組各20例(A組給予經(jīng)枕頸融合術(shù)治療,B組給予經(jīng)C1-2釘棒復(fù)位內(nèi)固定術(shù)治療。)術(shù)前影像學(xué)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(shù)前頸椎MRI檢查顯示所有病例均存在脊髓受壓,術(shù)前JOA評分平均為8.3±1.5分。患者分別行枕頸融合術(shù)(后路枕骨-樞椎螺釘間撐開復(fù)位內(nèi)固定術(shù))及C1-2釘棒復(fù)位內(nèi)固定技術(shù)(寰椎椎弓根螺釘內(nèi)固定術(shù)),術(shù)后所有患者復(fù)查X線、頸椎三維、CT查看手術(shù)效果及樞椎螺釘?shù)奈恢?并進(jìn)行JOA評分,評價(jià)手術(shù)效果。為臨床枕頸融合術(shù)及寰樞椎椎弓根螺釘內(nèi)固定提供解剖學(xué)依據(jù),對臨床應(yīng)用結(jié)果進(jìn)行評估分析。結(jié)果:全部手術(shù)均安全完成,術(shù)中無脊髓及椎動(dòng)脈損傷等嚴(yán)重并發(fā)癥。平均用時(shí)3.8小時(shí)(3~6小時(shí)),平均出血約260ml(200~500ml)。所有患者癥狀較術(shù)前明顯好轉(zhuǎn),術(shù)后第一天JOA評分平均為12.2±1.5分,較術(shù)前明顯改善(p0.05)。術(shù)后復(fù)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(gè)月,術(shù)后平均隨訪14.1±3.7個(gè)月,末次隨訪時(shí)JOA評分平均為14.8±2.1分,較術(shù)前及術(shù)后第一天均有改善(p0.05)。隨訪期間未出現(xiàn)一例內(nèi)固定松動(dòng)斷裂現(xiàn)。結(jié)論:寰樞椎脫位后路固定術(shù)(頸枕融合術(shù)及C1-2釘棒復(fù)位內(nèi)固定技術(shù))在臨床上的應(yīng)用具有能改善患者生活質(zhì)量,改善頸椎功能,療效確切,安全可靠,值得推廣應(yīng)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(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 移平;譚明生;呂國華;楊峰;唐向盛;郝慶英;周英杰;張恩忠;姜良海;劉楚吟;齊英娜;;督脈瘀阻型寰樞椎脫位手術(shù)聯(lián)合中藥治療的臨床研究[J];中國中醫(yī)骨傷科雜志;2017年01期

2 何保華;朱偉;夏虹;鄭小飛;;BMP-2混合自體髂骨植骨在寰樞椎脫位后路復(fù)位固定融合術(shù)中的應(yīng)用[J];中國骨與關(guān)節(jié)損傷雜志;2016年09期

3 武樂成;倪斌;;寰樞椎脫位術(shù)中復(fù)位技術(shù)及內(nèi)固定的研究進(jìn)展[J];中華創(chuàng)傷骨科雜志;2016年06期

4 蔣晨晨;劉揚(yáng);;陳舊性寰樞椎脫位前后路聯(lián)合松解復(fù)位固定術(shù)的配合體會(huì)[J];淮海醫(yī)藥;2016年02期

5 李來華;張永福;侯兵;;后路釘棒撐開復(fù)位內(nèi)固定及植骨融合術(shù)治療寰樞椎脫位的療效分析[J];中華神經(jīng)外科雜志;2016年01期

6 白尚君;;經(jīng)后路撐開復(fù)位內(nèi)固定術(shù)治療難復(fù)性寰樞椎脫位患者的效果觀察[J];臨床醫(yī)學(xué)研究與實(shí)踐;2016年01期

7 趙保輝;張韶輝;崔青;張建華;;經(jīng)后路椎板內(nèi)固定治療顱頸畸形合并寰樞椎脫位的臨床研究[J];國際醫(yī)藥衛(wèi)生導(dǎo)報(bào);2015年21期

8 段光明;李重先;李慶林;迭風(fēng)云;;寰-枕融合與自發(fā)性寰-樞椎脫位發(fā)生機(jī)制的有限元研究[J];中華神經(jīng)外科疾病研究雜志;2015年05期

9 孫儉娟;;經(jīng)口咽松解后路復(fù)位固定融合術(shù)治療寰樞椎脫位的護(hù)理體會(huì)[J];世界最新醫(yī)學(xué)信息文摘;2015年69期

10 郭勝利;喬廣宇;余新光;周定標(biāo);;自發(fā)性寰樞椎脫位內(nèi)固定技術(shù)的研究進(jìn)展[J];中華神經(jīng)外科雜志;2015年07期

，

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