经口咽入路微型钛板内固定治疗不稳定寰椎骨折

Unstable atlas fractures treated by minitype titanium plate fixation through transoral approach

目的探讨不稳定型寰椎骨折经口咽入路微型钛板内固定治疗的临床疗效。方法采用回顾性病例系列研究分析2008年6月-2014年6月经口咽入路微型钛板内固定治疗21例横韧带完整的不稳定寰椎骨折患者，其中男15例，女6例；年龄21～57岁[（40．9±10．6）岁]。前1／2Jefferson骨折12例，半环Jefferson骨折9例。患者均有明显的颈椎活动受限。术前视觉模拟评分（VAS）4～9分[（7．6±1．3）分]。术前颈椎活动度：屈曲（15．4±3．9）°，伸展（10．8±2．5）°，左侧屈（18．3±3．1）°，右侧屈（18．9±2．7）°，左侧旋转（21．8±5．8）°，右侧旋转（22．4±4．6）°。记录手术时间、术中出血量、术后3dVAS；术后3个月复查颈椎x线片及颈椎CT、VAS，测量颈椎屈曲、伸展、左侧屈、右侧屈、左侧旋转、右侧旋转活动度，评估颈椎活动度；观察骨折愈合情况。结果手术时间（86．3±25．3）min，术中出血量（120．5±33．3）ml。与术前比较，术后3dVAS0—3分[（1．6±0．4）分]（P〈0．05）。随访12～48个月[（23．7±5．9）个月]。与术前、术后3d比较，术后3个月VAS0～2分[（0．6±0．1）分]（P〈0．05）。术后3个月颈椎活动度：屈曲（38．6±4．5）°、伸展（39．3±4．0）°、左侧屈（39．2±4．0）°、右侧屈（39．2±2．9）°、左侧旋转（66．8±8．8）°、右侧旋转（66．3±9．2）°，与术前比较差异均有统计学意义（P〈0．05）。术后无切口感染、椎动彬脊髓损伤。所有患者骨折愈合良好，未见内固定松动或断裂，颈部屈伸旋转活动无明显受限。结论经口咽入路微型钛板内固定治疗不稳定寰椎骨折创伤小、愈合率高，可保留上颈椎活动功能。

Objective To investigate the effect of minitype titanium plate fixation through transoral approach in the treatment of unstable atlas fractures. Methods A retrospective case series study was made on 21 patients with unstable atlas fractures treated by minitype titanium plate fixation through transoral approach from June 2008 to June 2014. There were 15 males and 6 females, at age of （40.9 ± 10.6）years （range, 21 to 57 years）. Anterior 1/2 Jefferson fractures were seen in 12 patients and 1/2 ring Jefferson fractures in 9 patients. Preoperative visual analogue score （VAS） was 4-9 points [ （ 7.6 ± 1.3 ） points ]. Before operation, degree of mobility of the cervical vertebra was （ 15.4 ± 3.9） °in bending, （ 10.8 ±2.5） °in extending, （ 18.3 ± 3.1 ）° in left-bending, （ 18.9 ± 2.7 ）° in right-bending, （21.8 ± 5.8 ）° in left-rotation and （ 22.4 ± 4.6 ） ° in right-rotation. Operation time, intraoperative blood loss, VAS, cervical mobility and bone healing were detected after operation. Results Operation time was （86.3 ±25.3）min, and intraoperative blood loss was （120.5 ±33.3）ml. VAS was improved to 0-2 points [ （ 1.6 ± 0.4 ） points ] at postoperative 3 days （ P 〈 0.05 ）. All patients were followed up for 12 to 48 months [ （23.7 ± 5.9） months ]. VAS was improved to 0-2 points [ （0.6 ± 0.1 ） points ] at postoperative 3 months （P 〈0.05 ）. Degree of mobility of the cervical vertebra was improved significantly at postoperative 3 months, with the bending of（38.6 ± 4.5 ） °, extending of （ 39.3 ± 4.0）°, left-bending of （ 39.2 ± 4.0）°, right-bending of （39.2 ±2.9）°, left-rotation of （66.8 ±8.8）° and right-rotation of （66.3 ± 9.2 ） ° （ p 〈 0. 05 ）. Postoperatively, there were no surgical wound incision infections and vertebral artery or spinal injuries. Bone union was found in all patients, without the occurrence of implant loosening or breakage and the dysfunction of the cervical vertebra. Conclusion Minitype titanium plate fixation through transoral approach is associated with less trauma, high healing rate and preservation of the activity of cervical vertebra in the treatment of unstable atlas fractures.