椎弓根钉内固定治疗Ⅱ型齿状突骨折术中植骨融合与非植骨融合的临床疗效比较
Clinical analysis of pedicle screw fixation in the treatment of type Ⅱ odontoid fracture with bone grafting and non-bone grafting
目的 比较植骨与否在椎弓根螺钉内固定治疗Ⅱ型齿状突骨折的近期临床疗效.方法 对14例Ⅱ型齿状突骨折8例(A组)行后入路椎弓根钉复位固定,椎板间自体髂骨植骨;6例(B组)单纯行后入路椎弓根螺钉内固定.观察手术时间、手术出血量及术后第3个月颈椎屈伸及旋转功能,并随访5~45个月.结果 所有患者获得随访时间5~45个月,平均26.5个月.植骨组手术时间(1.83±0.50)h,非植骨组手术时间(1.58±0.90)h,两组差异有统计学意义(t=2.842,P>0.05).植骨组出血(150±16)mL,非植骨组出血(120±14)mL,两组差异有统计学意义(t=3.57,P>0.05).3个月后植骨组颈椎屈曲(31.2±4.6)°,非植骨组颈椎屈曲(32.3±5.7)°,两组差异有统计学意义(t=0.675,P<0.05).植骨组旋转(40.6±4.5)°,非植骨组旋转(41.3±3.5)°,两组差异有统计学意义(t=0.278,P<0.05).两组均无椎动脉和脊髓损伤,伤口一期愈合.随访期间两组患者颈椎复位良好,无内固定松动、断裂、骨折愈合好,A组植骨块融合.结论 对于该类型骨折单纯行寰枢椎椎弓根内固定相比较联合自体髂骨植骨融合治疗,可节省手术时间、减少出血量.
更多Objective To explore the clinical efficacy of bone grafting in the treatment of type Ⅱ odontoid fracture with pedicle screw fixation .Methods Of 14 cases with type Ⅱ odontoid fractures ,8 patients in group A received pedicle screw,lamina autologous bone grafts,6 cases of group B received simple posterior pedicle screw fixation.The operative time ,the amount of surgical bleeding and the postoperative cervical spine flexion and rotationwere observed at 3 months postoperatively ,and the patients were followed up for 5-45 months.Results All patients were followed up for 5-45 months,with an average of 26.5 months.The operation time was (1.83 ±0.5) h in the bone graft group,and (1.58 ±0.9)h in the non-bone graft group,the difference was statistically significant (t=2.842,P>0.05).The blood loss of the bone graft group was (150 ±16)mL,which of the non-bone graft group was (120 ±14) mL,the difference between the two groups was statistically significant (t =3.57,P >0.05).After 3 months,the flexion of the cervical spine of the bone graft group was (31.2 ±4.6)°,which in the non -grafted group was (32.3 ±5.7)°,the difference was statistically significant (t=0.675,P<0.05).The rotation of the bone graft group was (40.6 ±4.5)°,which in the non -graft group was (41.3 ±3.5)°,the difference was statistically significant (t=0.278,P<0.05).Both two groups had no vertebral artery and spinal cord injury ,wound healing. During the follow-up period,the two groups of patients had a good reduction of cervical spine ,no internal fixation lossening,fracture,fracture healing well,group A bone graft fusion.Conclusion For this type of fracture,simple atlantoaxial pedicle screw fixation compared with autologous iliac bone graft fusion treatment ,can save the operation time,reduce the amount of bleeding .
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