寰椎椎弓根螺钉置入的解剖学及临床效果分析
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摘要
目的研究寰椎椎弓根螺钉置入的解剖学及临床效果。方法选取46例由承德医学院解剖教研室提供的健康完整的寰椎标本予以解剖学测量,明确寰椎椎弓根螺钉进钉点与置钉的角度。选取2013年3月—2015年3月于承德医学院附属医院接受后路寰枢椎切开复位内固定术治疗的寰枢椎不稳患者30例为对照组,置钉方式为传统置钉。另取2015年8月—2017年8月同院接受后路寰枢椎切开复位内固定术治疗的寰枢椎不稳患者33例为实验组,以局部解剖标志为参考的寰椎徒手椎弓根置钉方式置钉。比较两组各项手术指标,手术前后Oswestry功能障碍指数问卷表(ODI)及日本骨科协会评估治疗分数(JOA评分),术后并发症发生情况。结果实验组手术时间、术中失血量、置钉时间均低于对照组,差异有统计学意义(P <0.05)。手术前后两组患者ODI及JOA评分比较差异无统计学意义(P>0.05);而术后两组患者ODI评分均低于术前,JOA评分均高于术前,差异有统计学意义(P <0.05)。结论以局部解剖标志为参考的寰椎徒手椎弓根置钉方式置钉效果更佳,有利于改善患者的脊柱功能以及颈椎功能。
Objective To study anatomical and clinical effect of atlas pedicle screw implantation. Methods A total of 46 atlas sample were measured by crew from Department of Anatomy, Chengde Medical College for information of entry point and angle of pedicle screws. Totally 30 cases of control group who were admitted into our hospital from March 2013 to March 2015 underwent posterior atlantoaxial internal fixation by conventional pedicle screw way for treatment of atlantoaxial instability. Another 33 cases in experimental group who were admitted into our hospital during August 2015 to August 2017 underwent posterior atlantoaxial internal fixation with local anatomical landmarks for treatment of atlantoaxial instability. The operation indexes, ODI and JOA score before and after surgery, and postoperative complications were recorded in two groups. Results operation time, intraoperative blood loss and insertion time in experimental group were decreased significantly when compared with those in control group(P < 0.05). No obvious differences in ODI and JOA scores pre-and post-surgery were identified between groups(P > 0.05). ODI was decreased while JOA was increased post-surgery greatly in both groups when compared with that prior to surgery(P < 0.05). Conclusion Local anatomical landmarks is a promising pre-surgery evaluating system for atlas screw placement.
Objective To study anatomical and clinical effect of atlas pedicle screw implantation. Methods A total of 46 atlas sample were measured by crew from Department of Anatomy, Chengde Medical College for information of entry point and angle of pedicle screws. Totally 30 cases of control group who were admitted into our hospital from March 2013 to March 2015 underwent posterior atlantoaxial internal fixation by conventional pedicle screw way for treatment of atlantoaxial instability. Another 33 cases in experimental group who were admitted into our hospital during August 2015 to August 2017 underwent posterior atlantoaxial internal fixation with local anatomical landmarks for treatment of atlantoaxial instability. The operation indexes, ODI and JOA score before and after surgery, and postoperative complications were recorded in two groups. Results operation time, intraoperative blood loss and insertion time in experimental group were decreased significantly when compared with those in control group(P < 0.05). No obvious differences in ODI and JOA scores pre-and post-surgery were identified between groups(P > 0.05). ODI was decreased while JOA was increased post-surgery greatly in both groups when compared with that prior to surgery(P < 0.05). Conclusion Local anatomical landmarks is a promising pre-surgery evaluating system for atlas screw placement.
引文
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[8]韩岳,夏群,徐宝山,等."徒手法"个体化颈椎椎弓根螺钉技术治疗上颈椎骨折脱位[J].中华创伤杂志,2011,27(2):110-114.
[9]张少杰,王星,张元智,等.个性化导航模板辅助儿童颈椎椎弓根螺钉置入与徒手置入准确性的对比研究[J].中国脊柱脊髓杂志,2014,24(11):1020-1024.
[10]董春科,李配瑶,谭明生,等.后路辅助寰椎椎弓根螺钉置钉技术的研究进展[J].中国矫形外科杂志,2016,24(20):1884-1887.
[2]付兆宗,陈忠羡,梁胜根,等.寰椎后弓椎板钩联合枢椎椎弓根螺钉治疗寰枢椎脱位的临床研究[J].蚌埠医学院学报,2017,42(5):622-625.
[3]李长红,贺永进,王飞,等.螺旋CT结合图像后处理对上颈椎椎弓根的解剖学测量数据及临床意义探究[J].山西医药杂志,2016,45(9):1003-1006.
[4]石海浪,王欢,崔少千,等.颈椎减压手术治疗以坐骨神经痛为表现的颈腰综合征的临床效果分析[J].中国骨与关节杂志,2016,5(11):808-811.
[5]李金泉,龚冰南,徐皓,等.寰枢椎融合与颈枕融合治疗上颈椎疾患的临床疗效比较[J].中华临床医师杂志:电子版,2013,7(4):1544-1548.
[6]MORALES L C,ALVARADO F,CORREDOR J A,et al.Bilateral C1 laminar hooks combined with C2 pedicle screw fixation in the treatment of atlantoaxial subluxation after Grisel syndrome[J].Spine J,2016,16(12):755-760.
[7]赵文龙,倪斌,郭群峰,等.后路寰枢椎经关节螺钉结合寰椎椎板钩与寰枢椎椎弓根螺钉固定融合治疗寰枢椎脱位的疗效比较[J].中国脊柱脊髓杂志,2017,27(1):10-16.
[8]韩岳,夏群,徐宝山,等."徒手法"个体化颈椎椎弓根螺钉技术治疗上颈椎骨折脱位[J].中华创伤杂志,2011,27(2):110-114.
[9]张少杰,王星,张元智,等.个性化导航模板辅助儿童颈椎椎弓根螺钉置入与徒手置入准确性的对比研究[J].中国脊柱脊髓杂志,2014,24(11):1020-1024.
[10]董春科,李配瑶,谭明生,等.后路辅助寰椎椎弓根螺钉置钉技术的研究进展[J].中国矫形外科杂志,2016,24(20):1884-1887.