摘要
目的探讨钉板内固定系统行枕颈融合术治疗上颈椎失稳的临床疗效。方法选择2014年10月—2015年10月收治的上颈椎失稳61例,根据手术方式分为枕颈融合组30例和寰枢椎融合组31例,比较2组手术时间、术中出血量、住院时间、并发症及植骨融合情况,术后随访12个月,观察术前、末次随访时日本骨科协会评分(JOA)、视觉模拟疼痛评分量表(VAS)评分变化,评价颈部活动情况。结果枕颈融合组手术时间、术中出血量及住院时间长于或多于寰枢椎融合组(P<0.05)。2组末次随访VAS评分较术前下降,JOA评分较术前升高(P<0.05)。2组术中、术后均无并发症发生,均骨性融合。枕颈融合组末次随访颈椎屈伸活动度、颈椎曲度均小于寰枢椎融合组(P<0.05)。结论应用钉板内固定系统行枕颈融合术治疗上颈椎不稳效果满意,但对颈椎活动度影响大,临床建议严格掌握手术适应证。
Objective To investigate clinical effect of occipitocervical fusion by using nail plate internal fixation system in treatment of upper cervical spine instability. Methods A total of 61 patients with upper cervical spine instabil- ity admitted during October 2014 and October 2015 were divided into oecipitocervieal fusion group （n = 30） and atlanto- axial fusion group （n = 31 ） according to different surgery methods. Operation time, intraoperative volume of blood loss, hospitalization duration, complications and condition of bone graft fusion were compared in two groups. After operation, all patients were followed up for 12 months. Changes of Japanese Orthopaedic Association （JOA） and visual analogue scales （VAS） scores were observed before operation and at the time of last follow-up, and the conditions of neck activities were evaluated. Results Values of operation time, intraoperative volume of blood loss and hospitalization duration in oc- cipitoeervical fusion group were significantly more than those in atlantoaxial fusion group （ P 〈 0.05）. At the time of last follow-up, VAS scores were significantly lower, while JOA scores were significantly increased compared with those before operation in both groups （ P 〈 0.05）. In two groups, there were no complications during and after operation, all patients had bony fusion. At the last time of follow-up, degrees of cervical flexion and extension and cervical curvature in occipito- cervical fusion group were significantly lower than those in atlantoaxial fusion group （P 〈 0.05）. Conclusion Occipito- cervical fusion by using nail plate internal fixation system in treatment of upper cervical spine instability can achieve satis- factory effect, but the effect on cervical activity is obvious, and therefore clinicians should master the operation indications strictly.
出处
《解放军医药杂志》
CAS
2017年第7期62-65,共4页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
随州市医学科研项目(2015SMR025)
湖北省科技厅基金项目(BK2008254)
关键词
上颈椎失稳
枕颈融合术
钉板内固定系统
Upper cervical spine instability
Occipitocervical fusion
Nail plate internal fixation system
