本文選題：寰樞關節(jié)　切入點：脊柱融合術　出處：《重慶醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:觀察并對比頸枕融合與后路寰樞椎融合治療寰樞椎不穩(wěn)的臨床療效。方法:回顧分析我院2012年10月至2016年7月手術治療的寰樞椎不穩(wěn)患者47例,男30例,女17例,年齡16-79歲,平均54.7歲。根據(jù)固定節(jié)段不同將其分為頸枕融合(A組15例)、后路寰樞椎融合(B組32例),通過比較JOA評分改善率、頸椎屈曲、后伸和旋轉活動度、頸椎融合率評估患者臨床療效。對比兩組手術時間、術中出血量、術后3d引流量、住院時間之間的差異,并對結果進行統(tǒng)計學分析。結果:所有患者均順利完成手術,術后獲得6-48個月隨訪,平均21.4個月。兩組病例JOA改善率、住院時間、術后3d引流量及頸椎融合率差異無統(tǒng)計學意義(P0.05),但在手術時間、術中出血量、術后頸椎屈曲、后伸和旋轉活動度差異有統(tǒng)計學意義(P0.05),B組相較于A組擁有更短的手術時間,更少的術中出血量,對頸椎屈曲、后伸及旋轉活動度影響最小。結論:頸枕融合及后路寰樞椎融合均能獲得滿意的治療效果,但與頸枕融合相比,后路寰樞椎融合具有出血量少、手術時間短、頸椎屈伸和旋轉活動度喪失少等優(yōu)點,應當作為寰樞椎不穩(wěn)的首選手術方式。
[Abstract]:Objective: to observe and compare the clinical effects of cervical and occipital fusion and posterior atlantoaxial fusion in the treatment of atlantoaxial instability. Methods: from October 2012 to July 2016, 47 patients with atlantoaxial instability, 30 males and 17 females, were analyzed retrospectively. The patients were divided into two groups: group A (15 cases) with cervical and occipital fusion (n = 15) and group B (n = 32) with posterior atlantoaxial fusion. The improvement rate of JOA score, cervical flexion, extension and rotation were compared. The cervical fusion rate was used to evaluate the clinical effect of the two groups. The difference of operation time, intraoperative bleeding volume, drainage flow and hospitalization time between the two groups were compared. The results were statistically analyzed. Results: all the patients successfully completed the operation. There was no significant difference in JOA improvement rate, hospitalization time, drainage flow rate and cervical fusion rate between the two groups (P 0.05), but there was no significant difference between the two groups in the operation time, intraoperative blood loss and postoperative cervical flexion. The difference of extension and rotation activity was statistically significant. Compared with group A, group B had shorter operation time, less intraoperative bleeding, and lower cervical flexion. Conclusion: both cervical and occipital fusion and posterior atlantoaxial fusion can achieve satisfactory results, but compared with occipital fusion, posterior atlantoaxial fusion has less bleeding and shorter operative time. Cervical flexion and extension and less loss of rotation should be the first choice for atlantoaxial instability.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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