| Ⅰ期后路寰枢椎椎弓根螺钉复位固定非融合治疗青少年GrauerⅡB型齿突骨折 |
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投稿时间：2018-08-01
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| 作者 | Author | 单位 | Address | E-Mail |
| 许楠健 |
XU Nan-jian |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 陈云琳 |
CHEN Yun-lin |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 王小舟 |
WANG Xiao-zhou |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 蒋伟宇 |
JIANG Wei-yu |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 马维虎 |
MA Wei-hu |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
weihu_ma@163.com |
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| 期刊信息：《中国骨伤》2019年，第32卷，第3期，第254-259页 |
| DOI：10.3969/j.issn.1003-0034.2019.03.012 |
| 基金项目:浙江省自然科学基金项目（编号：LY18H060007） |
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中文摘要:
目的：探讨Ⅰ期后路寰枢椎椎弓根螺钉复位固定非融合治疗青少年GrauerⅡB型齿突骨折的临床疗效。
方法：2009年2月至2015年4月，采用Ⅰ期后路寰枢椎椎弓根螺钉复位固定非融合治疗19例不适合行前路齿突螺钉固定的GrauerⅡB型齿突骨折青少年患者，其中男14例，女5例，年龄14~32（24.6±5.0）岁。术后复查CT显示骨折骨性愈合后取出内固定。在末次随访时（内固定拆除至少1年以上）采用动力位CT评估寰枢椎旋转活动度的保留情况。记录第1次手术前、第2次手术（拆除内固定）前、末次随访时的疼痛视觉模拟评分（visual analogue scale，VAS）；采用颈椎功能障碍指数（Neck Disability Index，NDI）对第2次手术（拆除内固定）前、末次随访时的疗效进行评价。
结果：术后2例患者出现枕颈部麻木、疼痛等枕大神经刺激症状，给予脱水、营养神经等药物治疗，1~2个月后症状缓解。所有患者获第2次手术（拆除内固定）术后1年以上随访，随访时间18~25（21.47±2.41）个月。术后骨折骨性融合的时间为6~10（8.21±1.27）个月。骨折骨性愈合即行Ⅱ期手术拆除内固定，期间无内固定失败。术后患者颈痛症状明显改善，VAS评分由术前的6.74±0.65下降到第2次手术（拆除内固定）术后末次随访时的0.42±0.51，差异有统计学意义。NDI值由第2次手术（拆除内固定）前的（10.58±2.04）%下降到第2次手术（拆除内固定）术后末次随访时的（3.79±2.23）%，差异有统计学意义。第2次手术（拆除内固定）术后末次随访时，动力位CT显示寰枢椎单侧旋转活动度达到向左（15.73±5.57）°，向右（15.55±5.78）°，寰枢椎总体旋转活动度为（31.28±10.71）°。
结论：Ⅰ期后路寰枢椎椎弓根螺钉复位固定非融合治疗不适合行前路齿突螺钉固定的青少年GrauerⅡB型齿突骨折，可以避免寰枢关节融合，在一定程度上保留寰枢椎的旋转活动度。 |
| 【关键词】齿突骨折 内固定术 寰枢椎融合 旋转 活动范围 青少年 |
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| One stage temporary atlantoaxial segmental fixation and reduction for Grauer typeⅡB dens fractures in teenagers |
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ABSTRACT
Objective:To assess the clinical results of one stage temporary atlantoaxial segmental fixation and reduction for Grauer typeⅡB dens fractures in teenagers.
MethodsFrom February 2009 to April 2015,19 teenagers with Grauer typeⅡB dens fractures not amenable to anteiror screw fixation were enrolled and treated using one stage temporary atlantoaxial segmental fixation and reduction without fusion. There were 14 males and 5 females,aged from 14 to 32 years with an average of (24.6±5.0) years. The internal fixation was removed after bone healing confirmed by CT scan. At the last follow-up (at least 1 year after internal fixation removal),dynamic CT was used to assess the atlantoaxial rotation activity. Visual analogue scale (VAS) was recorded before the first operation,before the second operation (removal of internal fixation) and at the last follow-up. Neck Disability Index(NDI) was used to evaluate the efficacy before the second operation (removal of internal fixation) and the last follow-up.
ResultsAfter operation,2 patients developed the symptoms of occipital nerve stimulation such as numbness and pain in the occipitocervical region,and were treated with drugs such as dehydration and neurotrophic drugs,and the symptoms were relieved after 1 to 2 months. All the internal fixations were removed and all the patients were followed up more than 1 year,with time ranging from 18 to 25 months and an average of (21.47±2.41) months. The time of bone fusion after operation was 6 to 10 months with the mean of(8.21±1.27) months. Secondary surgical removal of internal fixation were performed immediately after fracture healing without internal fixation failure. The symptoms of neck pain improved significantly after operation,VAS score decreased from 6.74±0.65 before operation to 0.42±0.51 at the last follow-up after the second operation (removal of internal fixation),with statistically significant differences(P<0.01). The NDI value decreased from (10.58±2.04)% before the second operation (removal of internal fixation) to (3.79±2.23)% at the last follow-up after the second operation (removal of internal fixation),with statistically significant difference(P<0.01). At the last follow-up after the second operation (removal of internal fixation),dynamic CT showed that the unilateral rotation of the atlantoaxial spine reached (15.73±5.57)°to the left,(15.55±5.78)° to the right,and the overall rotation of the atlantoaxial spine was (31.28±10.71)°.
ConclusionOne stage temporary atlantoaxial segmental fixation and reduction for the treatment of Grauer typeⅡB dens fractures not amenable to anteiror screw fixation in teenagers can avoid the loss of atlantoaxial rotation function caused by atlantoaxial fusion,and to some extent retain the rotation activity of atlanto-axial joint. |
| KEY WORDS Dens fracture Internal fixation Atlantoaxial fusion Rotation Range of motion Teenagers |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 许楠健,陈云琳,王小舟,蒋伟宇,马维虎.Ⅰ期后路寰枢椎椎弓根螺钉复位固定非融合治疗青少年GrauerⅡB型齿突骨折[J].中国骨伤,2019,32(3):254~259 |
| 英文格式: | XU Nan-jian,CHEN Yun-lin,WANG Xiao-zhou,JIANG Wei-yu,MA Wei-hu.One stage temporary atlantoaxial segmental fixation and reduction for Grauer typeⅡB dens fractures in teenagers[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(3):254~259 |
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