【摘要】：目的 :探討成人寰椎骨折的治療策略。方法 :2013年5月~2015年12月我科共收治成人單純寰椎骨折患者58例,男31例,女27例;年齡18~72歲(45.3±14.0歲)。7例穩(wěn)定寰椎骨折患者采用硬頸圍固定;22例不伴橫韌帶斷裂的不穩(wěn)定寰椎骨折患者,采用頭頸胸支具固定20例,halo支具固定2例;29例伴橫韌帶斷裂的不穩(wěn)定寰椎骨折患者,采用后路寰樞椎內(nèi)固定融合術(shù)20例,后路寰椎單椎節(jié)內(nèi)固定術(shù)9例。對(duì)患者進(jìn)行常規(guī)隨訪,記錄美國(guó)脊髓損傷協(xié)會(huì)(ASIA)分級(jí)、疼痛視覺模擬評(píng)分(VAS)以及治療相關(guān)并發(fā)癥。采用CT評(píng)估骨折愈合情況和植骨融合情況,采用頸椎動(dòng)力位X線片評(píng)估寰樞椎穩(wěn)定性。結(jié)果:所有患者隨訪12~24個(gè)月(14.3±4.0個(gè)月)。隨訪CT示,采用硬頸圍固定的7例穩(wěn)定寰椎骨折及采用頭頸胸支具或halo架固定的22例不伴橫韌帶斷裂的不穩(wěn)定寰椎骨折均獲得骨性愈合。20例行后路寰樞椎內(nèi)固定融合術(shù)的伴有橫韌帶斷裂的不穩(wěn)定寰椎骨折有18例獲得骨性融合,2例未融合但內(nèi)固定仍牢靠。頸椎動(dòng)力位X線片示9例行后路寰椎單椎節(jié)內(nèi)固定術(shù)的患者均無寰樞椎失穩(wěn)征象。治療前ASIA分級(jí)D級(jí)4例,E級(jí)54例;末次隨訪ASIA分級(jí)均為E級(jí)(Z=-2.000,P=0.046)。治療前VAS評(píng)分為4~8分(6.6±1.0分),末次隨訪為0~2分(0.4±0.7分)(Z=-6.682,P0.001)。保守治療者有2例枕部發(fā)生皮膚壓瘡;手術(shù)者術(shù)中均無神經(jīng)血管損傷,術(shù)后2例發(fā)生切口感染。結(jié)論:對(duì)于穩(wěn)定的寰椎骨折,采用硬頸圍固定即可;對(duì)于不伴橫韌帶斷裂的不穩(wěn)定寰椎骨折,采用頭頸胸支具或halo架固定可取得良好療效;對(duì)于伴有橫韌帶斷裂的不穩(wěn)定寰椎骨折,采用后路寰樞椎內(nèi)固定融合術(shù)或后路寰椎單椎節(jié)內(nèi)固定術(shù)均可獲得較滿意的療效。
[Abstract]:Objective: to explore the treatment strategy of adult atlantovertebral fracture. Methods: from May 2013 to December 2015, 58 adult patients with simple atlas fracture were treated, including 31 males and 27 females, aged 1872 years (45.3 鹵14.0 years). In 22 cases of unstable atlantovertebral fracture without rupture of transverse ligament, 20 cases were fixed with thoracic brace and 2 cases with halo. 29 cases of unstable atlantovertebral fracture with transverse ligament rupture were treated with posterior atlantoaxial fixation fusion in 20 cases and posterior atlantoaxial single segment fixation in 9 cases. Patients were routinely followed up to record the American Spinal Cord injury Association (Asci) (ASIA) grade, pain visual analogue score (VAS), and treatment-related complications. Fracture healing and bone graft fusion were evaluated by CT and the stability of atlantoaxial vertebrae was evaluated by cervical dynamic X-ray. Results: all patients were followed up for 12 ~ 24 months (14.3 鹵4.0 months). Follow-up CT showed that, Bone healing was achieved in 7 cases of stable atlantoaxial fractures and 22 cases of unstable atlantovertebral fractures without transverse ligament rupture, which were fixed with head and neck thoracic brace or halo frame. 20 cases were treated with posterior atlantoaxial fixation fusion. Bone fusion was obtained in 18 cases of unstable atlantovertebral fractures with rupture of transverse ligament. 2 cases were not fused, but internal fixation was still reliable. X-ray films of cervical dynamic position showed no atlantoaxial instability in 9 patients who underwent posterior atlantoaxial single segment fixation. There were 4 cases with ASIA grade D and 54 cases with E grade before treatment, and all of them had ASIA grade E after the last follow up (ZP0. 046). The VAS score was 4 ~ 8 (6.6 鹵1. 0) before treatment and 0 ~ 2 (0. 4 鹵0. 7) at the last follow-up (P 0. 001). There were 2 cases of occipital skin pressure ulcer in conservative treatment and 2 cases of incision infection. Conclusion: for the stable atlantovertebral fracture, the rigid neck fixation can be used, and for the unstable atlantovertebral fracture without transverse ligament fracture, the head and neck thoracic brace or halo frame fixation can obtain good curative effect. For unstable atlantovertebral fractures with rupture of transverse ligament, posterior atlantoaxial fixation fusion or posterior atlantoaxial single segment fixation can obtain satisfactory results.
【作者單位】： 西安交通大學(xué)附屬紅會(huì)醫(yī)院脊柱外科;
【分類號(hào)】：R687.3

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本文編號(hào)：2316218