寰枢椎椎弓根螺钉内固定治疗齿状突骨折合并寰枢椎脱位

目的 探讨后路寰枢椎椎弓根螺钉内固定治疗齿状突骨折合并寰枢椎脱位的临床疗效.方法 2006年4月至2008年9月收治17例齿状突骨折合并寰枢椎脱位的患者,男11例,女6例;年龄23～65岁,平均37.1岁.齿状突骨折按照Anderson分型:Ⅱ型12例,Ⅲ型5例.患者均有寰枢椎脱位或半脱位,寰枢椎脱位按Fielding分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型10例,Ⅳ型2例.经术前颅骨牵引,采用后路椎弓根螺钉,行寰枢椎复位、固定及植骨融合,对其疗效进行随访.结果 本组17例患者共置椎弓根螺钉68枚,螺钉位置均满意.所有患者随访12～38个月(平均18个月),四肢肌力、感觉均有不同程度恢复.脊髓功能按照日本骨科协会(JOA)评分:术前平均为(10.2±2.4)分(5～15分),术后末次随访时为(15.7±1.9)分(13～17分),差异有统计学意义(t=9.078,P<0.05).随访时脊髓功能改善率为35%～95%,平均68.5%.无神经症状加重、硬膜破裂、椎动脉损伤、伤口感染及断钉等并发症.结论 后路寰枢椎椎弓根螺钉系统可为齿状突骨折合并寰枢椎脱位患者提供牢固的三维固定,是一种有效的治疗方法.

Treatment of dens fracture combined with recoverable atlantoaxial dislocation with posterior fusion plus pedicle screw

Objective To report the clinical results of posterior fusion plus pediele screw fixation for treatment of dens fracture combined with recoverable atlantoaxial dislocation. Methods From April 2006 to September 2008,17 cases of dens fractures combined with recoverable atlantoaxial dislocation were treated with posterior pedicle screw fixation.reduction and fusion.Skull traction was made to restore the normal atlantoaxial joint before the operation.The spinal cord functions were evaluated by the system of Japanese Orthopaedics Association(JOA). Results Followups for 12 to 38 months(average,18 months)showed that the aflantoaxial alignment and stability were restored in all the patients,without complications due to instrumentation.The average JOA scores improved significantly from the preoperative 10.2±2.4 points to the 15.7±1.9 at the last followup(t=9.078,P<0.05).The follow-ups showed that the functional improvement rate of spinal cord ranged from 35%to 95%,averaging 68.5%. Conclusion Since posterior atlantoaxial pedicle screw and rod fixation provides immediate three-dimensional rigid fixation of the atlantoaxial joint,it may be a more effective technique than previously reported techniques.