“in-out-in”多皮质枢椎椎弓根螺钉在寰枢椎脱位或不稳后路手术中的应用

Application of "in-out-in" multi-cortical C2 pedicle screw in posterior approach for atlantoaxial dislocation or instability

中文关键词:  枢椎  椎弓根螺钉  寰枢椎脱位  寰枢椎不稳

英文关键词:Axis  Pedicle screw  Atlantoaxial dislocation  Atlantoaxial instability

中文摘要:

  【摘要】 目的：探讨应用“in-out-in”多皮质枢椎椎弓根螺钉后路融合内固定治疗寰枢椎脱位或不稳的临床疗效。方法：回顾性分析2014年1月～2016年1月，采用“in-out-in”多皮质枢椎椎弓根螺钉后路融合内固定治疗的26例寰枢椎脱位或不稳患者资料，男17例，女9例，年龄25～63岁，平均43±9岁；单侧椎动脉高跨10例，双侧高跨2例，C2/3融合致单侧枢椎椎弓根发育不良12例，双侧发育不良2例。患者均表现为颈部疼痛，VAS评分1～6分，平均3.12±2.13分；23例伴肌力下降及感觉异常，日本矫形外科协会（JOA）评分为5～11分，平均7.9±2.1分。术前行X线、CT和MRI检查，术后7d及3、6、12个月行X线和CT检查，观察植骨融合情况；比较各时间点VAS及JOA评分。结果：手术顺利完成，手术时间125～215min（153.7±27.9min）；出血量160～650ml（263.1±68.5ml），3侧椎弓根钉应用“in-out-in”技术置钉过程中，出血多，改为椎板钉；无脊髓血管损伤及其他严重并发症发生。患者均获得8～20个月随访，平均12±4个月，术后6个月影像学检查见植骨均融合，无内固定松动，断裂发生。术后7d、3个月、6个月及末次随访时VAS评分分别为1.13±0.72、1.11±0.93、1.09±0.98及1.07±0.81分，较术前明显减轻（P＜0.05）；术后7d、3个月、6个月及末次随访时JOA评分分别为12.9±1.8、13.4±2.3、13.6±1.9及13.8±2.1分，与术前比较明显改善（P＜0.05）。结论：“in-out-in”多皮质枢椎椎弓根螺钉后路融合内固定治疗寰枢椎脱位或不稳，临床疗效肯定。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical effect of "in-out-in" multi-cortical C2 pedicle screw placement for the treatment of atlantoaxial dislocation or instability. Methods: Twenty-six patients with atlantoaxial dislocation or instability were treated by posterior fusion and fixation with "in-out-in" multi-cortical C2 pedicle screw fixation from January 2014 to January 2016. There were 17 males, 9 females, aged 25-63 years(mean 43±9 years); unilateral high-riding vertebral artery was found in 10 cases, bilateral high-riding in 2 cases, unilateral axial pedicle dysplasia due to C2-3 congenital fusion was found in 12 cases, bilateral dysplasia in 2 cases. Patients presented with neck pain, VAS score of 1-6 points(average, 3.12±2.13) was noted; 23 cases presented with decreased neurofunction, the Japanese Orthopedic Association(JOA) score was 5-11 points(average of 7.9±2.1 points). X-ray, CT and MRI were performed before operation and 7 days, 3, 6, 12 months after operation. X-ray and CT examination were used to observe the fusion of bone grafts. VAS score and JOA score were compared at each time point. Results: The operation time was 125-215min(153.7±27.9min). The bleeding volume was 160-650ml(263.1±68.5ml). The "in-out-in" technology screw process suspended due to high bleeding and was changed to translaminar screws; no spinal cord or vascular injury and other serious complications was noted. All patients were followed up for 8-20 months(mean, 12±4 months). At 6 months postoperatively, bone graft fusion was obtained and there was no instrument failure. The VAS score was 1.13±0.72, 1.11±0.93, 1.09±0.78 and 1.07±0.81 points at 7 days, 3 months, 6 months and the final follow-up respectively, compared with preoperative ones, there existed significant differences(P＜0.05). The JOA score was 12.9±1.8, 13.4±2.3, 13.6±1.9 and 13.8±2.1 points at 7 days, 3 months, 6 months and the final follow-up respectively, compared with preoperative ones, there existed significant differences(P＜0.05).