目的:评估双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的中长期疗效。方法:回顾性分析85例在我院接受双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合术的可复性寰枢椎脱位患者的临床资料,其中男21例,女64例;年龄25~65岁(...目的:评估双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的中长期疗效。方法:回顾性分析85例在我院接受双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合术的可复性寰枢椎脱位患者的临床资料,其中男21例,女64例;年龄25~65岁(44±9.4岁)。寰椎爆裂性骨折19例,C1、2旋转脱位畸形16例,齿状突骨折26例,齿状突游离15例,寰椎类风湿性关节炎致寰枢椎脱位9例。通过Ranawat分级、颈椎功能障碍指数(NDI)以及颈部/枕骨下疼痛视觉模拟量表(visual analogue scale,VAS)评分评估患者的临床疗效;在术前和末次随访时的颈椎正侧位X线片、MRI、CT三维重建等资料中,提取以下影像学数据:寰齿前间距(atlanto-dental interval,ADI)、有效椎管容积(space available for cord,SAC)、C1-2角、C2-7角,并观察植骨融合情况及颈椎稳定性。结果:所有患者均完成5年以上的随访。末次随访时24例术前存在脊髓压迫症状患者的Ranawat分级有所改善;95%的患者颈部疼痛得到缓解,VAS评分由术前7.56±1.03分下降至2.53±0.53分(P<0.05);NDI由术前34.76±5.45分降至13.13±1.21分(P<0.05)。ADI由术前6.5±1.0mm降至2.4±0.9mm(P<0.05);SAC由术前13.37±2.11mm增大至19.93±2.20mm(P<0.05)。手术前C1-2角为21.9°±1.2°,末次随访时为26.6°±6.9°;手术前C2-7角为19.8°±9.2°,末次随访时为15.5°±5.9°。术后6个月,81例(95.3%)患者获得良好的植骨融合,4例患者出现植骨延迟愈合。结论:双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的长期疗效优良,是一种安全、可靠的后路寰枢椎固定融合技术。展开更多
目的比较寰枢椎椎弓根螺钉固定融合疗法与后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合疗法治疗中寰枢椎脱位的临床疗效。方法采用回顾性分析方式,以2018年1月至2021年1月广安市人民医院入院的74例寰枢椎脱位患者为研究对象,根据治疗方...目的比较寰枢椎椎弓根螺钉固定融合疗法与后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合疗法治疗中寰枢椎脱位的临床疗效。方法采用回顾性分析方式,以2018年1月至2021年1月广安市人民医院入院的74例寰枢椎脱位患者为研究对象,根据治疗方法分为对照组(n=37)与实验组(n=37);对照组行寰枢椎椎弓根螺钉固定融合疗法;实验组行后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合疗法。比较两组患者的手术情况(术中出血量、手术时间)、植骨融合率、手术前后颈部僵硬度、颈椎功能障碍指数、生活质量(躯体机能、躯体职能、躯体疼痛、一般健康、活力、社会功能、情感角色限制、心理健康)评分与疼痛评分。结果实验组较对照组术中出血量更低[(207.05±31.54)m L vs.(229.48±33.25)m L],手术时间更短[(123.85±9.22)min vs.(130.94±10.03)min],差异均有统计学意义(P<0.05)。实验组患者的植骨融合率为100.0%,与对照组的97.29%比较,差异无统计学意义(P>0.05)。术前,两组患者的颈部僵硬度、颈椎功能障碍指数、生活质量及疼痛评分比较,差异无统计学意义(P>0.05);术后6个月,两组术后颈部僵硬轻度、重度率与颈椎功能障碍指数、疼痛评分均较术前明显降低,生活质量评分较术前明显增高,差异均有统计学意义(P<0.05);两组患者的颈部僵硬轻度、重度率与颈椎功能障碍指数、生活质量及疼痛评分相比,差异无统计学意义(P>0.05)。结论寰枢椎椎弓根螺钉固定融合疗法与后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合疗法治疗寰枢椎脱位的临床疗效均显著,但后者出血量更低,时间更短。展开更多
Importance Congenital hemivertebra is commonly treated with posterior hemivertebra resection with bilateral transpedicular fixation.However,implant‐related complications are common in children younger than 5 years ol...Importance Congenital hemivertebra is commonly treated with posterior hemivertebra resection with bilateral transpedicular fixation.However,implant‐related complications are common in children younger than 5 years old who undergo this surgical procedure.Objective To present the preliminary clinical and radiological outcomes of children younger than 5 years old treated by posterior hemivertebra resection and 3‐rod fixation technique.Methods From January 2016 to December 2017,14 consecutive patients of congenital scoliosis with 16 hemivertebrae were retrospectively reviewed,including 5 girls and 9 boys,aged between 25 and 55 months old(average,37.6 months).All patients underwent posterior hemivertebra resection with short fixation with bilateral pedicle screws and a convex lamina hook.Surgical complications and corrective outcomes were assessed based on the clinical charts and spinal radiographs with a minimum 24‐month follow‐up.Results The mean Cobb angle of the main curve was 38.4°before surgery,8.5°after surgery,and 8.7°at final follow‐up.In the compensatory cranial curve,the preoperative Cobb angle of 16.8°was corrected to 8.1°postoperatively and was 10.3°at final follow‐up.In the compensatory caudal curve,the preoperative Cobb angle of 15.9°improved to 5.3°postoperatively and was 7.8°at final follow‐up.The segmental kyphosis was corrected from 13.5°to 0.5°and was 1.1°at final follow‐up.There were no crankshaft phenomena,no proximal kyphosis,and no complications related to the instrumentation.Interpretation Posterior hemivertebra resection with instrumentation with bilateral pedicle screws and a convex lamina hook can achieve rigid fixation and deformity correction.展开更多
文摘目的:评估双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的中长期疗效。方法:回顾性分析85例在我院接受双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合术的可复性寰枢椎脱位患者的临床资料,其中男21例,女64例;年龄25~65岁(44±9.4岁)。寰椎爆裂性骨折19例,C1、2旋转脱位畸形16例,齿状突骨折26例,齿状突游离15例,寰椎类风湿性关节炎致寰枢椎脱位9例。通过Ranawat分级、颈椎功能障碍指数(NDI)以及颈部/枕骨下疼痛视觉模拟量表(visual analogue scale,VAS)评分评估患者的临床疗效;在术前和末次随访时的颈椎正侧位X线片、MRI、CT三维重建等资料中,提取以下影像学数据:寰齿前间距(atlanto-dental interval,ADI)、有效椎管容积(space available for cord,SAC)、C1-2角、C2-7角,并观察植骨融合情况及颈椎稳定性。结果:所有患者均完成5年以上的随访。末次随访时24例术前存在脊髓压迫症状患者的Ranawat分级有所改善;95%的患者颈部疼痛得到缓解,VAS评分由术前7.56±1.03分下降至2.53±0.53分(P<0.05);NDI由术前34.76±5.45分降至13.13±1.21分(P<0.05)。ADI由术前6.5±1.0mm降至2.4±0.9mm(P<0.05);SAC由术前13.37±2.11mm增大至19.93±2.20mm(P<0.05)。手术前C1-2角为21.9°±1.2°,末次随访时为26.6°±6.9°;手术前C2-7角为19.8°±9.2°,末次随访时为15.5°±5.9°。术后6个月,81例(95.3%)患者获得良好的植骨融合,4例患者出现植骨延迟愈合。结论:双侧经寰枢关节螺钉寰椎椎板钩固定植骨融合治疗可复性寰枢椎脱位的长期疗效优良,是一种安全、可靠的后路寰枢椎固定融合技术。
文摘目的比较寰枢椎椎弓根螺钉固定融合疗法与后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合疗法治疗中寰枢椎脱位的临床疗效。方法采用回顾性分析方式,以2018年1月至2021年1月广安市人民医院入院的74例寰枢椎脱位患者为研究对象,根据治疗方法分为对照组(n=37)与实验组(n=37);对照组行寰枢椎椎弓根螺钉固定融合疗法;实验组行后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合疗法。比较两组患者的手术情况(术中出血量、手术时间)、植骨融合率、手术前后颈部僵硬度、颈椎功能障碍指数、生活质量(躯体机能、躯体职能、躯体疼痛、一般健康、活力、社会功能、情感角色限制、心理健康)评分与疼痛评分。结果实验组较对照组术中出血量更低[(207.05±31.54)m L vs.(229.48±33.25)m L],手术时间更短[(123.85±9.22)min vs.(130.94±10.03)min],差异均有统计学意义(P<0.05)。实验组患者的植骨融合率为100.0%,与对照组的97.29%比较,差异无统计学意义(P>0.05)。术前,两组患者的颈部僵硬度、颈椎功能障碍指数、生活质量及疼痛评分比较,差异无统计学意义(P>0.05);术后6个月,两组术后颈部僵硬轻度、重度率与颈椎功能障碍指数、疼痛评分均较术前明显降低,生活质量评分较术前明显增高,差异均有统计学意义(P<0.05);两组患者的颈部僵硬轻度、重度率与颈椎功能障碍指数、生活质量及疼痛评分相比,差异无统计学意义(P>0.05)。结论寰枢椎椎弓根螺钉固定融合疗法与后路寰枢椎经关节螺钉结合寰椎椎板钩固定融合疗法治疗寰枢椎脱位的临床疗效均显著,但后者出血量更低,时间更短。
文摘Importance Congenital hemivertebra is commonly treated with posterior hemivertebra resection with bilateral transpedicular fixation.However,implant‐related complications are common in children younger than 5 years old who undergo this surgical procedure.Objective To present the preliminary clinical and radiological outcomes of children younger than 5 years old treated by posterior hemivertebra resection and 3‐rod fixation technique.Methods From January 2016 to December 2017,14 consecutive patients of congenital scoliosis with 16 hemivertebrae were retrospectively reviewed,including 5 girls and 9 boys,aged between 25 and 55 months old(average,37.6 months).All patients underwent posterior hemivertebra resection with short fixation with bilateral pedicle screws and a convex lamina hook.Surgical complications and corrective outcomes were assessed based on the clinical charts and spinal radiographs with a minimum 24‐month follow‐up.Results The mean Cobb angle of the main curve was 38.4°before surgery,8.5°after surgery,and 8.7°at final follow‐up.In the compensatory cranial curve,the preoperative Cobb angle of 16.8°was corrected to 8.1°postoperatively and was 10.3°at final follow‐up.In the compensatory caudal curve,the preoperative Cobb angle of 15.9°improved to 5.3°postoperatively and was 7.8°at final follow‐up.The segmental kyphosis was corrected from 13.5°to 0.5°and was 1.1°at final follow‐up.There were no crankshaft phenomena,no proximal kyphosis,and no complications related to the instrumentation.Interpretation Posterior hemivertebra resection with instrumentation with bilateral pedicle screws and a convex lamina hook can achieve rigid fixation and deformity correction.
