牵引治疗成人外伤性寰枢椎半脱位
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作者Author单位AddressE-Mail
张丽梅 ZHANG Li-mei 开化县人民医院, 浙江 开化 324300 Kaihua County People's Hospital, Kaihua 324300, Zhejiang, China 704665376@qq.com 
徐艳 XU Yan 开化县人民医院, 浙江 开化 324300 Kaihua County People's Hospital, Kaihua 324300, Zhejiang, China  
朱久勇 ZHU Jiu-yong 开化县人民医院, 浙江 开化 324300 Kaihua County People's Hospital, Kaihua 324300, Zhejiang, China  
期刊信息:《中国骨伤》2020年,第33卷,第9期,第883-886页
DOI:10.12200/j.issn.1003-0034.2020.09.018
基金项目:
中文摘要:目的:观察改良后的牵引疗法在成人外伤性寰枢椎半脱位中的应用。

方法:对2018年3月至2019年6月收治的31例寰枢椎半脱位患者进行回顾性分析,男15例,女16例;年龄18~68岁,平均39岁,其中18~40岁者10例,41~60岁者15例,51~68岁者6例。主要表现为颈部活动受限,疼痛,寰枢椎CT平扫示不同程度寰枢椎半脱位。运用三维多功能牵引床,牵引2 min,放松10 s,牵引角度以后伸位5°~10°,重量3~6 kg开始,每两天增加重量1 kg,至症状改善后,并以此重量维持治疗。牵引时间为30 min,每天牵引2次,10 d为1个疗程。寰枢椎间隙左右欠等宽1~2 mm者牵引1个疗程,3~4 mm者牵引2个疗程,特别疑难严重者如寰枢椎间隙左右欠等宽4 mm常规疗程无好转者,疗程可以增至3个月。治愈:颈部无疼痛,颈部活动正常范围,CT检查示寰枢椎间隙正常,齿突居中;治疗结束1个月后随访颈部活动正常者。好转:颈部疼痛明显好转,CT检查示寰枢椎间隙左右欠等宽1 mm者。

结果:31例患者中,1个疗程治愈者17例;2个疗程治愈者11例,好转2例;3个月治愈者1例。

结论:改良后的牵引疗法对成人外伤性寰枢椎半脱位,特别是寰枢椎间隙左右欠等宽3~4 mm的半脱位,有明显的疗效,且此法安全、可靠,患者无不适,疗效较好。
【关键词】成人  外伤性寰枢椎半脱位  牵引术
 
Traction for the treatment of traumatic atlantoaxial subluxation in adults
ABSTRACT  Objective: To observe the application of modified traction therapy in traumatic atlantoaxial subluxation in adults.

Methods: The clinical data of 31 patients with atlantoaxial subluxation treated from March 2018 to June 2019 were restropectively analyzed. There were 15 males and 16 females,aged from 18 to 68 years old with an average of 39 years old,including 10 cases of 18-40 years,15 cases of 41-60 years,6 cases of 51-68 years. The main manifestations of the patients were limited neck movement,pain,and atlantoaxial CT scan showed different degrees of atlantoaxial subluxation. Three-dimensional multifunctional traction bed was used for traction for 2 min,relaxation for 10 s. The traction angle starts from the rearward extension of 5°-10° and weight from 3-6 kg. The weight increased by 1 kg every two days until the symptoms were improved. Traction time was 30 min twice a day and 10 days for a course of treatment. One course of treatment was performed in patients with 1-2 mm left and right equal width of atlantoaxial space,and two courses of treatment were performed in patients with 3-4 mm left and right equal width of atlantoaxial space,and the course of treatment could be increased to 3 months in especially patients with serious problems,such as 4 mm left and right equal width of atlantoaxial space and no improvement after conventional treatment. The criteria to evaluate the clinical effect was cure:no pain in the neck,normal range of neck movement,CT showed normal atlantoaxial space and odontoid process was in the middle,patients with normal neck movement were followed up 1 month after the end of treatment;improvement:neck pain was significantly improved and CT showed that the left and right atlantoaxial space was less than 1 mm in equal width.

Results: Among the 31 patients,17 cases were cured by one course of treatment,11 cases were cured by 2 courses of treatment,and 2 cases were improved.

Conclusion: The modified traction therapy has obvious effect on adult traumatic atlantoaxial subluxation,especially the subluxation of 3-4 mm equal width in left and right atlantoaxial space,and this method is safe and reliable with good efficacy and the patients without discomfort.
KEY WORDS  Adult  Traumatic atlantoaxial subluxation  Traction
 
引用本文,请按以下格式著录参考文献:
中文格式:张丽梅,徐艳,朱久勇.牵引治疗成人外伤性寰枢椎半脱位[J].中国骨伤,2020,33(9):883~886
英文格式:ZHANG Li-mei,XU Yan,ZHU Jiu-yong.Traction for the treatment of traumatic atlantoaxial subluxation in adults[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(9):883~886
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