改良植骨方法在后路寰枢关节和枕颈融合内固定术中的应用

A modified bone graft method for posterior atlantoaxial arthrodesis and occipitocervical fixation

中文关键词:  上颈椎不稳  寰枢关节  枕颈融合术  植骨  内固定

英文关键词:Upper cervical instability  Atlantoaxial joint  Occipitocervical fixation  Bone graft  Internal fixation

中文摘要:

  【摘要】 目的：探讨改良植骨方法在寰枢关节和枕颈融合内固定术中的应用价值。方法：2011年1月～2013年1月，对32例因齿状突不连（21例）、寰椎横韧带断裂或松弛导致寰枢关节不稳（6例）以及颅底凹陷（5例）的病例，施行了后路经C1侧块或椎弓根螺钉和C2椎弓根或Magerl螺钉固定术（27例）或枕颈固定术（5例）。术中植骨时在C1和C2后弓或C2和枕骨间植入颗粒状松质骨，压实后将少许稍长的皮质骨条铺在表面，再放置明胶海绵2条，用可吸收线缠绕在两侧内置物上或缝合于两侧软组织上，形成网状结构，术后颈托固定，随访观察患者植骨融合情况。结果：所有患者均顺利完成手术。1例经口咽前路松解复位后路椎弓根螺钉内固定患者，出现术后咽后间隙感染，经积极抗感染治疗，于术后2周恢复。术中无内固定或植骨困难，术后随访未见复位丢失或假关节形成。32例均获得随访，时间5个月～3年2个月，平均19.1±7.2个月，全部患者手术后3～6个月获得骨性融合。结论：在寰枢关节和枕颈融合内固定术中应用改良植骨方法，可获得满意的融合率。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical results of a modified bone graft method for posterior atlantoaxial arthrodesis and occipitocervical fixation. Methods: A modified bone graft method was designed. From January 2011 to January 2013, 32 patients including odontoid nonunion in 21 patients, atlantoaxial instability in 6 patients and basilar invagination in 5 patients, there were 27 cases undergoing posterior atlantoaxial arthrodesis, and 5 cases undergoing occipitocervical fixation plus this bone graft method. The autogenous granulated cancellous bone was grafted between the arch of C1 and C2 or the arch of C2 and occipital. A few cortical bone chips were laid on the surface of compacted cancellous bone graft. Following the placement of two pieces of gelatin sponge, absorbable suture was used to fix the structure on internal fixation device or soft tissue bilaterally and form a net structure. All patients were followed up and immobilized by cervical collar after operation. The bone union rate was reviewed. Results: All patients completed operation successfully and were followed up for an average of 19.1±7.2 months(5-38 months). There was 1 case with postoperative retropharyngeal infection after transoral release and posterior reduction by pedicle screw instrumentation. The infection was controlled after two weeks of antibiotic therapy. In this series, all cases showed satisfactory screw fixation and bone graft intraoperatively and no incidence of postoperative reduction loss or pseudarthrosis was noted. All cases presented with bony union at 3-6 months of follow-up. Conclusions: Solid fusion can be achieved for posterior atlantoaxial arthrodesis and occipitocervical fixation by using this modified bone graft method.