【作者】 张强； 马华松；

【Author】 ZANG Qiang,MA Hua song.Department of Orthoaedics,The 306 Hospital of PLA,Beijing 100101, China

【机构】 解放军第306医院骨科；

【摘要】 [目的]探讨颈椎后路寰枢椎椎弓根螺丝钉固定技术在治疗齿状突骨折合并寰枢关节脱位中的临床疗效。[方法]2006年12月～2009年3月对9例齿状突骨折合并寰枢关节脱位患者采用颈椎后路寰枢椎椎弓根螺丝钉固定技术治疗。其中男7例,女2例,年龄19岁～56岁,平均39.3岁;新鲜齿状突骨折并寰枢椎脱位7例,陈旧性骨折脱位2例;齿状突骨折按照Anderson分型:Ⅱ型7例,Ⅲ型2例。术前神经功能按照JOA评分9～15分,平均11.2分。术前常规进行颅骨牵引治疗7～14 d,平均10 d。手术均在全麻麻醉下进行,直视下复位,行寰枢椎椎弓根螺丝钉内固定术。[结果]术中无椎动脉、脊髓和神经根损伤发生。9例齿状突骨折和寰枢椎脱位均完全复位;术后第3～6 d在颈托保护下下地活动,术后随访3～20月,平均15月,临床症状得到明显的改善;术后12个月时复查X片结果显示所有的骨折已经愈合,内固定的位置好,无内植物的松动、断裂。术后12个月评估神经功能JOA评分在13～17分,平均15.4分,同术前有统计学差异。[结论]颈椎后路寰枢椎椎弓根螺丝钉固定技术在治疗齿状突骨折合并寰枢关节脱位具有直视下复位完全、短节段固定保持颈椎的活动度、颈椎固定可靠、能够取得良好骨折愈合和稳定的寰枢椎融合效果。更多还原

【Abstract】 [Objective]To explore the clinical outcome of C1-2 pedicle screw fixation on odontoid fracture associated with dislocation of atlantoaxial joint.[Method]9 patients with odontoid fracture associated with dislocation of atlantoaxial joint underwent C1-2 pedicle screw fixation.There were 7 males and 2 femals, with a mean age 39.3 years old(range from 19 to 56 years old).7 cases were fresh fracture and 2 were old ones.The odontoid fractures were classified according to Anderson-D’Alonzo,which includes AndersonⅡfor 7 cases and AndersonⅢfor 2 cases.JOA scores of neurologic function were 11.2(from 9 to 15) before operation.Skull traction was used in all cases before operation for 10 days(from 7 to 14 days). All patients were operated under general anesthesia.The dislocations of atlantoaxial joint were reduced in view and all cases were operated with C1-2 pedicle screw fixation.[Results]9 cases with odontoid fracture associated with dislocation of atlantoaxial joint were reduced completely,without vertebral artery,spine or never root injuried.The off-bed times were 3 to 6 days after operation.All patients were followed up for 3 to 20 months,mean15 months.The X-ray of 12 months after operation showed all odontoid fractures had healed,with no loosen or broken of the internal fixation.The postoperative JOA scores were 15.4 at 12months’ follow-up.[Conclusion]C1-2 pedicle screw fixation odontoid fractures associated with dislocation of atlantoaxial joint have the advantages of reduction completely in view,short-segment fixation and high fusion rate of atlantoaxial joint,which could be used as an effective method for stabilizing atlantoaxial joint.更多还原