寰枢固定非融合治疗无横韧带断裂的成人不稳定型寰椎骨折

Effect of posterior atlantoaxial fixation and non-fusion technique in the treatment of unstable atlas fractures without transverse ligament rupture

目的 观察寰枢固定非融合技术在无横韧带断裂的成人不稳定型寰椎骨折中的临床疗效。方法 回顾性分析2015年6月~2017年12月治疗的31例不稳定型寰椎骨折。分别于术前、术后2周及末次随访时获得患者颈部NDI评分、R-J线高度以及末次随访时的骨折愈合情况等数据,对患者术前及术后的功能及影像学参数的改变进行评估。结果 与术前相比,术后2周及末次随访时,两组患者颈部NDI评分、R-J线高度均有显著改善(P<0.05);术后2周与末次随访比较,颈部NDI评分的差异有统计学意义(P<0.05),R-J线高度的差异无统计学意义(P>0.05)。末次随访时骨折愈合率达94.74%。结论 后路寰枢固定非融合手术治疗成人不稳定型寰椎骨折,可取得满意的临床效果,且非融合为后期内固定取出后寰枢椎运动功能的恢复提供了解剖学基础。

Objective To observe the clinical efficacy of atlantoaxial fixation and non-fusion technique in the treatment of unstable atlas fractures without transverse ligament rupture.Methods From June 2015 to December 2017,the clinical data of 31 patients with unstable atlas fractures were analyzed.The NDI score,R-J line height were obtained before operation,at 2 weeks after operation and at the last follow-up.The healing rate of the fracture at the last follow-up was also obtained.Results The NDI score and R-J line height at 2 weeks after operation and the last follow-up had statistically significant differences compared with before operation(P<0.05).The difference of NDI score between 2 weeks after operation and the last follow-up was statistically significant(P<0.05),but the difference of R-J line height was not statistically significant(P>0.05).The fracture healing rate reached 94.74% at the last follow-up.Conclusion The posterior atlantoaxial fixation and non-fusion method can achieve satisfactory clinical results in the treatment of unstable atlantic vertebral fractures in adults,and non-fusion provides an anatomical basis for the restoration of atlantoaxial motor function after the internal fixation is removed.