Mayfield头架下采用C1侧块-C2椎弓根螺钉固定整复陈旧性寰枢椎脱位

Reduction by C1 lateral mass as well as C2 pedicle screw fixation and Mayfield skull traction for obsolete atlantoaxial dislocation

中文关键词:  寰枢椎脱位  复位  侧块螺钉  椎弓根螺钉  Mayfield头架

英文关键词:Atlantoaxial dislocation  Reduction  Lateral mass screws  Pedicle screw  Mayfield skull traction

中文摘要:

  【摘要】 目的：探讨Mayfield头架下单纯后路C1侧块-C2椎弓根螺钉复位固定并椎板间植骨融合治疗陈旧性寰枢椎脱位的临床效果。方法：自2008年7月～2011年7月，对于陈旧性寰枢椎脱位患者，以术前颈椎动力位X线片评估，寰枢椎活动度≥5°为病例纳入标准，采用Mayfield头架下单纯后路C1侧块-C2椎弓根螺钉复位固定术共治疗11例。其中男性7例，女性4例；年龄28～55岁，平均35.6岁。均采用Mayfield头架固定头部，钉棒置入满意后，后路钉棒纵向加压复位，并以下压C2、C3棘突力量进行辅助，寰枢关节复位满意后，取自体髂骨行后路C1-C2椎板间植骨融合。以VAS和JOA评分法，分别对轴性颈痛和神经功能情况行术前与术后随访对比评估分析，正中矢状位CT影像观察植骨融合情况。结果：平均手术时间为（2.8±1.2）h，平均术中出血量为（260±80）ml，术中无椎动脉及脊髓损伤。随访6~36个月，平均23个月。VAS评分由术前6.14±1.92分降低到末次随访的3.15±1.28分，JOA评分由术前10.57±2.12分提高到末次随访的14.22±2.76分，差异均具有统计学意义（P＜0.05）。所有病例均获满意复位，随访期间无复位丢失，内固定位置佳，无松动断裂，均于6个月获骨性融合，融合率达100%。结论：对于寰枢椎活动度≥5°的陈旧性寰枢椎脱位，Mayfield头架下C1侧块-C2椎弓根螺钉固定植骨融合术式是一种安全有效的后路手术方法。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcome of reduction by C1 lateral mass as well as C2 pedicle screw fixation and Mayfield skull traction for obsolete atlantoaxial dislocation. Methods: The inclusive criteria was the range of motion of atlantoaxial facet joint≥5° on dynamic radiographs. A total of 11 patients undergoing posterior surgical reduction by C1 lateral mass and C2 pedicle screw placement following Mayfield skull traction from July 2008 to July 2011 were reviewed retrospectively. There were 7 males and 4 females with a mean age of 35.6 years(range, 28-55 years). Mayfield skull traction was performed in all patients. After screws were placed in C1-2, axial compression of C1-2 and forward pushing of C2-3 spinal process was applied to achieve reduction, after reduction, C1-2 autogenic bony graft was performed. VAS and JOA score was respectively used to evaluate the axial neck pain and the neurological deficit, and the results were compared before and after operation. Bony fusion was observed by the midline sagittal CT images. Results: The average operation time was 2.8±1.2h, and the mean blood loss was 260±80ml. No intraoperative neurovascular injury was noted. All patients were followed up for 6-36 months, with an average of 23 months. The average VAS score at final follow-up(3.15±1.28) was significantly lower than that of preoperation(6.14±1.92)(P＜0.05).　The average JOA score at final follow-up(14.22±2.76) was significantly higher than that of preoperation(10.57±2.12)(P＜0.05). No loss of reduction or instrument failure was noted at final follow-up. Solid fusion was achieved in all 11 patients 6 months later. Conclusions: For cases with atlantoaxial dislocation and ROM of C1-2 facet ≥5°, C1 lateral mass and C2 pedicle screw fixation following Mayfield skull traction is reliable and effective.