PDF(Pubmed)
Abstract：
OBJECTIVE: To compare the clinical outcomes of transoral anterior Jefferson-fracture reduction plate (JeRP) and posterior screw rod (PSR) surgery for unstable atlas fractures via C1-ring osteosynthesis.
METHODS: From June 2009 to June 2022, 49 consecutive patients with unstable atlas fractures were treated by transoral anterior JeRP fixation (JeRP group) or PSR fixation (PSR group) and followed up at General Hospital of Southern Theatre Command of PLA; 30 males and 19 females were included. The visual analogue scale (VAS) score, Neck Disability Index (NDI), distance to anterior arch fracture (DAAF), distance to posterior arch fracture (DPAF), lateral mass displacement (LMD), Redlund-Johnell value, postoperative complications, and fracture healing rate were retrospectively collected and statistically analyzed.
RESULTS: Compared with that in the PSR group, the bleeding volume in the JeRP group was lower, and the length of hospital stay was longer. The VAS scores and NDIs of both groups were significantly improved after surgery. The postoperative DAAF and DPAF were significantly smaller after surgery in both groups. Compared with the significantly shorter DPAF in the PSR group, the JeRP group had a smaller DAAF, shorter LMDs and larger Redlund-Johnell value postoperatively and at the final follow-up. The fracture healing rate at 3 months after surgery was significantly greater in the JeRP group (p < 0.05).
CONCLUSIONS: Both C1-ring osteosynthesis procedures for treating unstable atlas fractures yield satisfactory clinical outcomes. Transoral anterior JeRP fixation is more effective than PSR fixation for holistic fracture reduction and short-term fracture healing, but the hospital stay is longer.
METHODS: From June 2009 to June 2022, 49 consecutive patients with unstable atlas fractures were treated by transoral anterior JeRP fixation (JeRP group) or PSR fixation (PSR group) and followed up at General Hospital of Southern Theatre Command of PLA; 30 males and 19 females were included. The visual analogue scale (VAS) score, Neck Disability Index (NDI), distance to anterior arch fracture (DAAF), distance to posterior arch fracture (DPAF), lateral mass displacement (LMD), Redlund-Johnell value, postoperative complications, and fracture healing rate were retrospectively collected and statistically analyzed.
RESULTS: Compared with that in the PSR group, the bleeding volume in the JeRP group was lower, and the length of hospital stay was longer. The VAS scores and NDIs of both groups were significantly improved after surgery. The postoperative DAAF and DPAF were significantly smaller after surgery in both groups. Compared with the significantly shorter DPAF in the PSR group, the JeRP group had a smaller DAAF, shorter LMDs and larger Redlund-Johnell value postoperatively and at the final follow-up. The fracture healing rate at 3 months after surgery was significantly greater in the JeRP group (p < 0.05).
CONCLUSIONS: Both C1-ring osteosynthesis procedures for treating unstable atlas fractures yield satisfactory clinical outcomes. Transoral anterior JeRP fixation is more effective than PSR fixation for holistic fracture reduction and short-term fracture healing, but the hospital stay is longer.
摘要：
■比较经口前杰斐逊骨折复位钢板（JeRP）和后钉棒（PSR）手术通过C1环接骨术治疗不稳定性寰椎骨折的临床效果。
■2009年6月至2022年6月，对49例不稳定性寰椎骨折患者行经口前路JeRP固定术(JeRP组)或PSR固定术(PSR组)治疗，并在我院随访，男30例，女19例。视觉模拟量表(VAS)评分,颈部残疾指数（NDI），距离前弓骨折（DAAF），到后弓骨折的距离（DPAF），侧向质量位移（LMD），Redlund-Johnell值,术后并发症,并对其骨折愈合率进行回顾性分析。
■与PSR组相比，JeRP组的出血量较低，住院时间更长。两组患者术后VAS评分及NDI评分均有明显改善。两组术后DAAF和DPAF均明显变小。与PSR组显著缩短的DPAF相比，JeRP组的DAAF较小,较短的LMD和较大的Redlund-Johnell在术后和最终随访时具有重要价值。JeRP组术后3个月的骨折愈合率明显高于对照组(P<0.05)。
■两种C1环接骨术治疗不稳定性寰椎骨折均取得了满意的临床效果。经口前路JeRP内固定术比PSR内固定术对整体骨折复位和短期骨折愈合更有效,但是住院时间更长。
■2009年6月至2022年6月，对49例不稳定性寰椎骨折患者行经口前路JeRP固定术(JeRP组)或PSR固定术(PSR组)治疗，并在我院随访，男30例，女19例。视觉模拟量表(VAS)评分,颈部残疾指数（NDI），距离前弓骨折（DAAF），到后弓骨折的距离（DPAF），侧向质量位移（LMD），Redlund-Johnell值,术后并发症,并对其骨折愈合率进行回顾性分析。
■与PSR组相比，JeRP组的出血量较低，住院时间更长。两组患者术后VAS评分及NDI评分均有明显改善。两组术后DAAF和DPAF均明显变小。与PSR组显著缩短的DPAF相比，JeRP组的DAAF较小,较短的LMD和较大的Redlund-Johnell在术后和最终随访时具有重要价值。JeRP组术后3个月的骨折愈合率明显高于对照组(P<0.05)。
■两种C1环接骨术治疗不稳定性寰椎骨折均取得了满意的临床效果。经口前路JeRP内固定术比PSR内固定术对整体骨折复位和短期骨折愈合更有效,但是住院时间更长。
