寰枢椎后路三点式固定的适应证与初步临床应用

The indication and preliminary clinical outcome of atlantoaxial tri-screw-rod fixation

中文关键词:  寰枢椎不稳  内固定  椎弓根螺钉  融合术

英文关键词:Atlantoaxial instability  Internal fixation  Pedicle scew  Fusion

中文摘要:

  【摘要】 目的：探讨寰枢椎后路经椎弓根钉棒系统“三点式”固定术式的适应证与初步临床疗效。方法：2008年6月~2010年6月共收治21例寰椎不能进行双侧侧块置钉的寰枢椎不稳患者，其中男12例，女9例，年龄17～53岁，平均34岁。临床均表现为不同程度的颈枕部疼痛和活动受限，影像学检查均示寰椎单侧侧块骨折、寰枢椎不稳。10例合并寰枢椎半脱位者术前先给予Halo架牵引复位，所有患者均采用寰椎单侧侧块螺钉、枢椎双侧椎弓根螺钉的“三点式”内固定及植骨融合术，术后颈围固定3个月。随访患者临床与影像学结果。结果：患者均顺利完成手术，未发生脊髓和椎动脉损伤。手术时间70～140min，平均92min。所有患者均获随访，随访时间6～24个月，平均14.2个月，所有患者术后3～6个月（平均4个月）植骨块均融合，未发现螺钉松动、脱出以及断钉、断棒等现象。颈部疼痛症状均基本消失，枕颈活动度保留，对患者生活无明显影响。结论：寰枢椎“三点式”固定具有较强的三维固定作用，结合术前牵引复位与术后颈围外固定，用于不能进行寰椎双侧侧块置钉的寰枢椎不稳患者可避免枕颈融合术导致的枕颈活动丧失。

英文摘要:

  【Abstract】 Objective：To evaluate the preliminary clinical outcome and indication of atlantoaxial tri-screw-rod fixation.Method：From June 2008 to June 2010，21 patients suffering from atlantoaxial instability underwent fusion and atlantoaxial tri-screw-rod fixation.There were 12 males and 9 females，aged from 17 to 53（mean 34 years）.They all presented with cervical pain and malfunction.The radiographical fingdings indicated atlantoaxial instability together with C1 lateral mass fracture.10 cases with atlantoaxial dislocation underwent preoperative skull traction and postoperative halo-vest.Result：The operation time was 70-140 minutes（average，92 minutes）.Patients were followed up for an average of 14.2 months（range，6-24 months）.No spinal cord or vertebral artery injuries were noted.All cases got bony fusion 3-6 months after operation（average，4 months）.No instrument failure was found at final follow-up.Conclusion：The atlantoaxial tri-screw-rod fixation technique provides good biomechanical force，which can be used in patients unavailable to bilateral C1 pedicle screw placement and avoid loss of ROM due to craniocervical fusion. 【Key words】 Atlantoaxial instability；Internal fixation；Pedicle scew；Fusion 【Author′s address】 Spinal Surgery Department，the First Affiliated Hospital of Nanhua University，Hengyang，Hunan，421001，China