手术结合功能锻炼治疗寰枢椎脱位的临床疗效

Clinical Effect of Surgery Combined with Functional Exercise on Atlantoaxial Dislocation

目的:基于传统中医骨伤科"动静结合"理论,观察手术结合功能锻炼治疗寰枢椎脱位的临床疗效。方法:2015年9月至2018年6月,纳入59例寰枢椎脱位患者,均采用寰枢椎椎弓根螺钉内固定术治疗,术后1~16周进行规范化的功能锻炼。采用JOA评分和颈椎X线评价患者脊髓功能改善率和颈椎活动度的改善情况,并记录手术时间、出血量及并发症。结果:59例寰枢椎脱位患者,随访时间12~67个月,平均(26.7±20.8)个月。JOA评分术前、末次随访分别为(9.7±2.3)和(15.4±1.3)分,脊髓功能改善率为78.08%;末次随访时各个方向上颈椎活动度较术前明显改善,差异有统计学意义(P<0.05)。结论:手术联合术后规范化功能锻炼,在提高脊髓功能改善率的同时,改善了颈椎活动度,充分体现了传统中医骨伤科"动静结合"的学术思想,值得临床进一步推广应用。

Objective:To observe the clinical efficacy of surgery combined with functional exercise in the treatment of atlantoaxial dislocation,which was based on the theory of"Taking Both Motion and Quiescence into Consideration".Methods:Fifty-nine cases suffering from atlantoaxial dislocation were treated with atlantoaxial pedicle screw fixation from September 2015 to June 2018.Standardized functional exercise was performed 1 to 16 weeks after surgery.The improvement of spinal cord function and the cervical vertebra activity were evaluated by JOA score and cervical X-ray.In addition,the operation time,bleeding volume and complications were recorded.Results:All patients were followed-up for 12 to 67 months with an average of(26.7±20.8)months.The preoperative and last follow-up of JOA score were(9.7±2.3),(15.4±1.3),and the spinal cord function improvement rate was 78.08%.There were significant differences in JOA scores and the range of cervical motion compared with before surgery(P<0.05).Conclusion:Atlantoaxial pedicle screw fixation combined with early postoperative functional exercise can improve the stability of the spine and improve the function of the spinal cord.It fully embodies the academic idea of"Taking Both Motion and Quiescence into Consideration"in traditional Chinese medicine orthopedics,which is worthy of further clinical promotion.