本文選題：前路 + 齒狀突��； 參考：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:評(píng)估應(yīng)用經(jīng)頸前路空心拉力螺釘固定技術(shù)在齒狀突骨折治療中的應(yīng)用價(jià)值。方法:回顧性分析福建醫(yī)科大學(xué)附屬第一醫(yī)院骨科(三級(jí)甲等醫(yī)院)自2005年7月到2014年3月收治的齒狀突骨折42例。II型37例,淺III型5例。其中男性25例,女性17例;年齡15-71歲,平均34±3.2歲。術(shù)中透視下行頸前路空心拉力螺釘內(nèi)固定。針對(duì)研究對(duì)象的手術(shù)時(shí)間、術(shù)中失血量、術(shù)后引流量、術(shù)后并發(fā)癥等進(jìn)行綜合分析,并隨訪齒狀突骨折愈合情況。并就該技術(shù)在臨床應(yīng)用中遇到的問題進(jìn)行探討分析。結(jié)果:本組隨訪時(shí)間(45±9.5)個(gè)月(5~108個(gè)月)。均使用1枚空心拉力螺釘(38±1.2)mm(36~40mm)固定,手術(shù)時(shí)間(85±15.4)min(60~110min),術(shù)中出血量(30±7.5)ml(10~50ml),術(shù)后引流量(23±6.2)ml(10~50 ml),住院天數(shù)(16±3.8)天(11~21天),骨性愈合時(shí)間12~24w,平均骨折愈合時(shí)間16.5±2.5w。術(shù)前頸部不適、活動(dòng)受限癥狀,手術(shù)后均獲得了良好緩解,2例伴隨明顯神經(jīng)癥狀患者術(shù)后均獲得不同程度的好轉(zhuǎn)。本組患者全部骨折復(fù)位,手術(shù)切口呈I級(jí)甲等愈合,無吞咽苦難、感染、呼吸困難、螺釘移位、螺釘斷裂等并發(fā)癥,3例患者出現(xiàn)喉上神經(jīng)損傷癥狀,經(jīng)對(duì)癥治療,癥狀基本緩解。術(shù)后隨訪骨折均愈合,效果滿意。Frankel分級(jí)(術(shù)前、術(shù)后):II型:E級(jí)(32例、35例),D級(jí)(3例、2例),A級(jí)(2例、0例);淺III型:E級(jí)(4例、5例),D級(jí)(1例、0例)。結(jié)論:經(jīng)頸前路單枚空心拉力螺釘技內(nèi)固定技術(shù)具有創(chuàng)傷小、出血少、并發(fā)癥發(fā)生率低、手術(shù)時(shí)間短、恢復(fù)快等優(yōu)點(diǎn),尤其能最大限度保留上頸椎生理活動(dòng)功能,是一種治療齒狀突骨折的安全有效的手術(shù)方法。為避免并發(fā)癥發(fā)生,術(shù)前應(yīng)嚴(yán)格選擇適應(yīng)證和規(guī)范的術(shù)中精細(xì)操作。國人齒狀突骨折適宜單枚螺釘固定。
[Abstract]:Objective: to evaluate the value of anterior cervical cannulated screw fixation in the treatment of odontoid fracture. Methods: from July 2005 to March 2014, 42 cases of odontoid process fractures, 37 cases of type II and 5 cases of superficial type III, were retrospectively analyzed in the Department of Orthopaedics (Grade 3A Hospital) of the first affiliated Hospital of Fujian Medical University. There were 25 males and 17 females, aged 15-71 years with an average age of 34 鹵3.2 years. The internal fixation of anterior cervical hollow pull screw was performed by fluoroscopy. The operative time, blood loss, postoperative drainage and postoperative complications were analyzed, and the healing of odontoid fracture was followed up. The problems encountered in the clinical application of this technique are discussed and analyzed. Results: the follow-up time was (45 鹵9.5) months (5 ~ 108 months). All patients were fixed with one hollow lag screw (38 鹵1.2) mm (36~40mm), the operative time was (85 鹵15.4) min (60~110min), the intraoperative bleeding volume was (30 鹵7.5) ml (10~50ml), the postoperative drainage volume was (23 鹵6.2) ml () 1050 ml), hospitalization days (16 鹵3.8) days (1121 days), the bone healing time was 1224 weeks, the average fracture healing time was 16.5 鹵2.5 ws. The symptoms of preoperative neck discomfort and limited movement were all improved in different degree after operation in 2 patients with obvious neurological symptoms. All of the patients had fracture reduction. The operative incision was grade I grade A healing, without swallowing suffering, infection, dyspnea, screw displacement, screw fracture and other complications in 3 patients with supralaryngeal nerve injury, which was treated with symptomatic treatment. The symptoms were basically relieved. All the fractures were healed after operation. The results were satisfactory. Frankel grade (before and after operation) was 30% type II grade E (32 cases, 35 cases), D grade (3 cases, 2 cases), grade A (2 cases, 0 cases), shallow type III, grade E (4 cases, 5 cases), grade D, grade D (1 case, 0 case). Conclusion: the technique of single hollow pull screw through anterior cervical approach has the advantages of less trauma, less bleeding, lower incidence of complications, shorter operation time and faster recovery, especially it can preserve the physiological function of the upper cervical spine to the maximum extent. It is a safe and effective method for the treatment of odontoid fracture. In order to avoid complications, the indication and standard fine operation should be strictly selected before operation. The fracture of odontoid process is suitable for single screw fixation in Chinese.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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