Hangman骨折两种气管插管全麻下短节段固定融合

Two approaches of intratracheal intubation under general anesthesia for short-segment instrumented fusion of Hangman fractures

摘要:

[目的] 比较两种气管插管全麻下短节段固定融合术治疗 Hangman 骨折的临床效果。[方法] 回顾性分析 2014 年 1 月—2019 年 6 月本院采用颈椎后路椎弓根螺钉固定融合治疗 Hangman 骨折的 37 例患者的临床资料。根据术前医患沟通结果， 24 例采用经口腔插管，另外 13 例采用经鼻腔插管。比较两组患者围手术期、随访及影像学资料。[结果]37 例患者均顺利完成手术，术中无血管、神经损伤等并发症发生。经口组喉部暴露时间和插管时间显著少于经鼻组 （P＜0.05），但两组 1 次置管成功率的差异无统计学意义 （P＞0.05）。两组手术时间、切口长度、术中失血量、麻醉相关并发症、下地时间、切口愈合等级、住院时间等的差异均无统计学意义（P＞0.05）。36 例患者随访时间平均（16.2±6.7）个月，两组恢复完全负重活动时间的差异无统计学意义 （P＞0.05）。术后随时间推移，两组患者 ASIA 分级、NDI 评分和 JOA 评分显著改善 （P＜0.05），相应时间点， 两组间上述指标的差异均无统计学意义 （P＞0.05）。影像方面，两组置钉准确性的差异无统计学意义 （P＞0.05），与术前相比， 末次随访两组颈椎前凸角、C_2~3滑移率均显著改善 （P＜0.05），相应时间点，两组间颈椎前凸角、C_2~3滑移率的差异无统计学意义（P＜0.05）。[结论]采用后路短节段椎弓根螺钉内固定融合术治疗不稳定 Hangman 骨折可取得满意的临床疗效，两种麻醉插管方法均安全可行。

Abstract:

[Objective] To compare the clinical outcomes of transoral (TO) versus transnasal (TN) intratracheal intubations under gener- al anesthesia for short-segment instrumented fusion of Hangman's fractures. [Methods] A retrospective study was performed on 37 patients who received posterior cervical pedicle screw fixation and fusion for Hangman's fractures in our hospital from January 2014 to June 2019. According to the results of preoperative doctor-patient communication, 24 patients underwent TO intubation, while the remaining 13 pa- tients received TN intubation. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All the 37 patients had operations performed successfully with no complications such as vascular nerve injury during the operation. The TO group proved significantly less laryngeal exposure time and intubation time than the TN group (P＜0.05), although there were no significant differ- ences in the success rate of catheterization on the first time, operation time, incision length, intraoperative blood loss, anesthesia- related complications, postoperative ambulation time, incision healing, and hospital stay between the two groups (P＞0.05). All of them in both groups were followed up for (16.2±6.7) months on a mean, and there was no significant difference in the time to return to full weight-bear- ing activities between the two groups (P＞0.05). The ASIA grade for neurological function, NDI and JOA scores improved significantly in both groups over time (P＜0.05), which were not significantly different between the two groups at any time points accordingly (P＞0.05). Re- garding image, there was no significant difference in screw placement accuracy between the two groups (P＞0.05). The cervical lordotic an- gle and C_2~3 slip ratio significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05), which were not found significantly different between the two groups at any corresponding time points (P＞0.05). [Conclusion] Posterior short-segment instrumented fusion does achieve satisfactory clinical outcomes for the treatment of unstable Hangman's fractures, and both transoral and transnasal intratracheal intubations under general anesthesia are safe and feasible.