摘要目的 探讨显微镜下徒手磨钻与常规徒手手钻寰椎置入椎弓根螺钉治疗不稳定寰椎爆裂骨折的疗效.方法 采用回顾性病例对照研究分析2016年1月一2018年6月宁波市第六医院收治的48例不稳定寰椎爆裂骨折患者临床资料,其中男32例,女16例;年龄24～72岁[(49.5±15.2)岁].22例采用显微镜下徒手磨钻寰椎置钉技术(A组),其中男14例,女8例;年龄24～68岁[(48.0±12.8)岁].26例采用徒手手钻寰椎置钉技术(B组),其中男18例,女8例;年龄26 ～72岁[(50.7±15.4)岁].比较两组手术时间、术中出血量、术中透视次数.术后1周内复查X线片及CT评估螺钉准确率.比较术前、术后1年颈痛视觉模拟评分(VAS)、颈部功能障碍指数(NDI).观察术中并发症情况.术后1年复查X线片及CT观察骨折愈合、寰枢椎融合情况及有无内固定物失败.结果 A组获随访12 ～24个月[(18.4±6.8)个月],B组获随访12 ～24个月[(17.4±7.2)个月].A组术中出血量[(180.5±60.8)ml]、术中透视次数[(1.3±0.8)次]较B组[(280.1±80.2)ml、(2.2士0.8)次]明显减少(P＜0.05),但手术时间及置钉准确率差异无统计学意义(P＞0.05).两组术后1年随访VAS、NDI与术前比较差异均有统计学意义(P＜0.05),而术前和术后1年随访VAS、NDI两组间差异均无统计学意义(P＞0.05).两组术中无椎动脉、神经根及脊髓损伤等严重并发症.术后1年随访CT示寰椎骨折愈合良好或寰枢椎间有连续骨桥通过.B组1例出现复位丢失,其余无内固定物松动、断裂.结论 与徒手手钻寰椎置钉相比,显微镜下徒手磨钻置入椎弓根螺钉治疗不稳定寰椎爆裂骨折临床疗效同样满意,且可减少术中出血量及透视次数.

abstractsObjective To investigate the efficacy of microscope-assisted free-hand atlantal pedicle screw technique for unstable atlas burst fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 48 patients with unstable atlas burst fracture admitted to Ningbo No.6 hospital from January 2016 to June 2018.There were 32 males and 16 females,aged 24-72 years [(49.5 ± 15.2 years)].A total of 22 patients were treated with the technique of atlas screw placement by drill under microscope (Group A),including 14 males and eight females,aged 24-68 years.Twenty six patients (Group B) were treated with atlantal pedicle screw placement by hand,including 18 males and 8 females,aged 26-72 years [(50.7 ± 15.4 years)].The operation time,intraoperative blood loss and the times of intraoperative fluoroscopy were compared between the two groups.X-ray and CT were reexamined to evaluate the accuracy of screw placement within one week after operation.The visual analogue score (VAS) and cervical dysfunction index (NDI) were compared before operation and 1 year after operation.The intraoperative complications were recorded.One year after operation,X-ray and CT were reexamined to observe fracture healing,aflantoaxial fusion and failure of internal fixation.Results Group A was followed up for 12-24 months [(18.4 ± 6.8)months],and Group B for 12-24 months [(17.4 ± 7.2) months].The amount of intraoperative bleeding [(180.5 ±60.8) ml] and the times of intraoperative fluoroscopy [(1.3 ±0.8) times] in Group A were significantly lower than those in Group B [(280.1 ± 80.2) ml,(2.2 ± 0.8) times] (P ＜ 0.05),but there was no significant difference in the time of operation and the accuracy of screw placement (P ＞ 0.05).There were statistically significant differences in VAS and NDI before operation and one year after operation in both groups (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).No serious complications such as vertebral artery,nerve root and spinal cord injury occurred.One year follow-up CT showed healed fracture or continuous bone bridge passing through the atlantoaxial intervertebral space.Except for one patient in Group B with lost reduction,other patients had no loosening or fracture of internal fixation.Conclusion Compared with screw placement by hand,the pedicle screw placement by drill under the microscope can reduce the amount of bleeding and the times of fluoroscopy.