摘要
目的评价钛缆内固定装置与钢丝内固定系统治疗儿童寰枢不稳的疗效。方法对62例儿童寰枢椎不稳患者施行后路固定及自体髂骨植骨融合术。其中钢丝固定30例,钛缆固定32例。64例患者均获得随访,平均随访时间6.5个月。结果两组患者平均手术时间(min)、平均手术出血量(ml)钛缆固定组分别为70 min和120 ml,钢丝固定组分别为110 min和160 ml,两组之间的差异有统计学意义(P<0.05)。30例钢丝固定患者中钢丝断裂、钢丝松脱、术后不全四肢瘫痪各1例,27例获骨性融合;32例钛缆固定患者中钢丝松脱1例,33例获骨性融合,未发生钛缆断裂、脊髓损伤等其他并发症。术后平均骨性融合时间(月)两组之间的差异没有统计学意义(P>0.05)。结论两种前路手术内固定器均具有良好的固定效果。钛缆内固定系统较之钢丝内固定装置手术操作安全,简单,植入方便,内固定坚强牢靠,可减少手术时间及手术出血量,植骨融合率高,并发症少。
Objective To evaluate the outcomes of the treatment of atlanto - axial instability with the use of two kinds of different posterior internal fixation apparatus system for atlanto - axial fusion in children. Methods Sixty two cases suffered from atlanto- axial instability from June 1993 to January 2004 were divided into 2 groups according to the use of different posterior internal fixation apparatus system. Steel wire group included 30 cases were managed by posterior internal fixation with steel wire and auto - iliac hone graft fusion;Titanium cable group included 32 cases were managed by posterior internal fixation with titanium cable and autoiliac hone graft fusion. The average follow- up was 6.5 months （ranging from 6 to 10 months）. Results There were significant differences in average operative time and average amount of bleeding in operation between the titanium cable group and steel wire group （ P 〈 0.05）. In 30 patients with steel wire fixation, complications of breaking, loosening of steel wires and postoperative incomplete quadriplegia occurred each in 3 cases, graft fusion succeeded in other 27 eases without complications; While 32 cases with titanium cable fixation,loosening d titanium cable occurred in one case,graft fusion succeeded in other cases without cord injury,cabh loosening and breakage. There was no significant difference in average graft fusion time between the titanium cable group and steel wire group （ P 〉 0.05）. Conclusions The two kinds of different posterior internal fixation apparatus system for atlanto- axial fusion in children can provide feasible effective strong fixation leading to excellent graft fusion. Compared with posterior internal fixation with steel wire and auto- iliac hone graft fusion, posterior internal fixation with titanium cable and auto - iliac hone graft fusion has easier and safer manipulation, less amount of bleeding, shorter operative time, fewer complications and higher rate of graft fusion.
