【摘要】 目的:探讨经后路寰枢椎椎弓根螺钉内固定治疗寰枢椎不稳的临床疗效。方法:2003年1月至2006年12月,采用寰枢椎经后路椎弓根螺钉内固定治疗C1-2不稳患者27例,男18例,女9例,年龄17~71岁,平均43.5岁。其中AndersonⅡ型齿状突骨折16例(陈旧性骨折7例,新鲜骨折9例),Ⅲ型陈旧性齿状突骨折1例,横韧带断裂4例,上颈椎肿瘤1例,先天性游离齿状突并寰枢椎不稳5例。患者均有不同程度的颈枕区疼痛,活动受限;影像学均有寰枢椎半脱位或不稳,JOA评分5~12分,平均8.6分。其中3例难复性脱位患者先行前路松解术;22例同时行植骨融合,5例单纯行内固定。随访治疗效果。结果:27例患者共置入螺钉108枚,其中有3例在置入寰椎椎弓根螺钉时后弓破裂,直接将螺钉固定在寰椎侧块上。手术时间1~3h,出血量100~400ml,术中有2例在剥离寰椎后弓下缘时损伤静脉丛,成功止血。术后X线片及CT显示2例一侧枢椎椎弓根螺钉部分进入椎动脉孔,1例螺钉偏内致椎弓根内侧皮质破裂,均无神经症状,其余螺钉位置良好,寰枢关节复位满意。所有患者均获随访,随访时间6~42个月,平均26个月,术后JOA评分13~17分,平均14.8分。未发生与螺钉相关的神经血管并发症,无内固定松动或断钉现象,22例植骨者术后随访时均已达到骨性融合,5例未行植骨患者1年后拆除内固定,寰枢关节旋转功能良好。结论:寰枢椎后路椎弓根螺钉技术是治疗寰枢椎不稳的有效方法。更多还原

【Abstract】 Objective:To explore the clinical outcomes of transpedicular instrumentation for the treatment of atlantoaxial instability.Method:From January 2003 to December 2006,27 cases with atlantoaxial instability under-went the transpedicular fixation were reviewed.There were 18 males and 9 females,with a mean age of 43.5 years(range,17 to 71 years).There were 8 cases of old odontoid fracture,9 cases fresh odontoid fracture,4 cases trau-matic disruption of transverse atlantal ligament,5 cases congenital loose odontoid process,1 case atlantoaxial tu-mour.JOA scores in preoperation were from 5 to 12,with an average of 8.6.3 cases of irreducible atlantoaxial dislo-cation were treated surgically by transoral anterior atlantoaxial release combined with reduction and internal fixation by means of posterior approach.5 cases were treated by the posterior reduction and internal fixation without bone grafts fusion.Result:Operative time ranged from 1 to 3 houres.Intraoperative blood loss was 250ml ranged from 100-400ml.A total of 108 screws were inserted safely.3 screws were inserted into lateral mass of the atlas directly be-cause of posterior arch breakage of the atlas caused by repeated drilling.There were no spinal cord and vertebral artery injury after surgery.Two screws were placed close to the vertebral artery canal,but without clinical conse-quences.One screw inserted so medially as to penetrating into the spinal canal,but no clinical response happened.Mean time of follow-up was 26 months(range,from 6 to 42 months).The postoperative JOA scores were from 13 to 17,with an average of 14.8.The clinical and radiologic follow-up data indicated solid fusion in 22 patients.Internal fixation system was removed one year after opration in 5 cases who were not received bone graft fusion and at-lantoaxial rotational function was restored satisfactorily.Conclusion:The transpedicular fixation is an effective method for the treatment of atlantoaxial instability.更多还原