对我国近20年来寰枢椎脱位外科治疗文献的统计分析

Review of surgical treatment of atlantoaxial dislocation in recent 20 years in Chinese

目的:统计分析我国近20年来寰枢椎脱位外科治疗文献,为合理选择术式提供依据。方法:以"寰椎"、"枢椎"、"寰枢椎"、"外科治疗"为关键词,检索1993年1月～2012年12月中国期刊全文数据库等4个国内权威数据库,及相关文章的国内外参考文献。纳入包含寰枢椎脱位具体手术方式的期刊文献,排除手术方式交代不清、同一单位或时间重复文献和护理类文献;统计分析内容:①文献来源的地区分布;②文献期刊源分布和引用频次及其排行;③手术例数的年度分布;④死亡率及手术并发症。结果:共检索到文献2929篇,符合纳入标准363篇,发表文献排名前三地区为广东、浙江、湖南,期刊为《中国脊柱脊髓杂志》、《中国骨与关节损伤杂志》、《中国矫形外科杂志》,被引用频次前三的文献为"寰椎测量及其经后弓侧块螺钉固定通道的研究"、"后路寰枢椎侧块钉板固定植骨融合术的临床初探"、"寰枢椎的解剖学测量及其临床意义"。文献病例总数7526例,1993～2000年病例数544例,手术方式主要为U型棒钢丝捆绑枕颈融合、Gallie钢丝、椎板夹等固定技术;2001～2006年病例数2673例,2007～2012年病例数4309例,主要术式为经寰枢椎侧块螺钉、椎弓根螺钉、枕颈钉板或经前路松解后路或前路一期复位螺钉固定技术。7526例手术患者中,死亡患者23例(0.31%);并发症依次为切口感染、静脉丛损伤、置钉错误、神经根损伤、术后再脱位和植骨不融合。结论:10年前我国寰枢椎脱位外科治疗是以后路非螺钉固定融合为主;近10年来,以寰枢椎"椎弓根"螺钉和侧块螺钉固定技术为主,特别是对难复性寰枢椎脱位具有良好的疗效,表明我国在该领域的研究有所创新,发表的原创手术治疗文献在国际上占有一定位置。

Objectives： To analyze the Chinese literatures of atlantoaxial dislocation in recent 20 years and optimize surgical approach for them. Methods： An online search of a total of 4 databases including CNKI from January 1993 to December 2012 using the key words ＂atlas＂, ＂axis＂, ＂atlantoaxial＂ and ＂surgical treatment＂ was performed; all references of literatures were also reviewed. The inclusive criteria included operative approaches, the literatures lack of detailed surgery and nursing articles were excluded. Statistical analysis index included： province distribution of literatures, origination and citation frequency of literature, annual amount of surgery for antlantoaxial dislocation, mortality and complications. Results： There were 363 out of 2929 literatures adopted in our study, most literatures came from the following provinces： Guangdong, Zhe- jiang, Hu＇nan. The journals cited were： Chinese Journal of Spine and Spinal Cord, Chinese Journal of Bone and Joint Injury, Orthopedic Journal of China. The three most cited literatures were ＂Anatomic study of atlas by using screw fixation via posterior arch and lateral mass＂, ＂Primary report of lateral mass fixation between atlas and axis by using screw-plate system＂, ＂Anatomical measurement of atlas and axis and its clinical significance＂. The amount of surgeries was 7526, and from 1993 to 2000, this number was 544, the main operation managements were occipital-cervical fusion by using U-shape rod, Gallic technique and lamina1 clamp; from 2001 to 2006, the number was 2673, from 2007 to 2012, the number was 4309, and the main operation managements were atlas lateral mass screw technique, atlas transpedicle screw technique, oceipital-cervi-ca1 plate-screw technique or one-stage anterior release and posterior or anterior fixation for irreducible atlantoaxial dislocation. The main complications included： injury of venous plexus, screw displacement, injury of nerve, incision infection and bone nunfusion. There were 23 deaths in 7526 patients（0.31%）. Conclusions： 10 years ago, Chinese main surgery for atlantoaxial dislocation is posterior non-screw fixation; while in recent 10 years, the main surgery is atlas transpedicle screw technique and atlas lateral mass screw technique, specially for irreducible atlantoaxial dislocation, which shows some improvements for atlantoaxial dislocation and original surgery in the world.