经后路寰枢椎椎弓根螺钉固定融合术治疗寰枢椎失稳

目的:探讨应用寰枢椎椎弓螺钉固定技术治疗寰枢椎失稳的临床疗效。方法:对2003年6月至2010年3月对收治的32例寰枢椎失稳患者采用寰枢椎椎弓根螺钉技术进行治疗,其中男21例,女11例;年龄28～66岁,平均42.5岁;齿状突骨折18例,先天性游离齿状突7例,Jefferson骨折合并齿状突骨折4例,类风湿性关节炎致寰枢椎不稳3例。所有患者均伴有寰枢椎半脱位或失稳。术前JOA评分4～14分,平均(9.1±0.3)分。术前完善颈椎X线(包括动力位片)、螺旋CT三维重建及MRI等影像学检查,在CT轴位片上对寰枢椎椎弓根螺钉的置入点、置入角度及钉道长度等数据进行测量,并行颅骨牵引术。手术在全麻下进行,直视下完成寰枢椎椎弓根螺钉的置入、复位和植骨融合,植骨块被向后预弯的横联紧紧卡压于寰椎后弓与枢椎椎板棘突之间。比较术前和术后6个月的JOA评分,并计算改善率。结果:32例患者共置入寰枢椎螺钉128枚,无脊髓、神经根和椎动脉损伤发生。所有患者获随访,时间6～48个月,平均16个月。术后JOA评分11～17分,平均(15.9±0.2)分,平均改善率为86.1%。骨折的齿状突均完全愈合,植骨块全部融合,无内固定断裂和松动。结论:寰枢椎椎弓根螺钉固定技术是治疗寰枢椎失稳的有效方法,具有固定牢靠,操作相对安全方便、融合率高等优点,值得临床应用。

Atlanto-axial pedicle screw fixation through posterior approach for treatment of atlanto-axial joint instability

Objective:To discuss the therapeutic effects of the atlantoaxial pedicle screw system fixation in treatment of atlantoaxial instability. Methods:From June 2003 to March 2010,32 patients with atlantoaxial instability were treated by atlantoaxial pedicle screw system fixation,included 21 males and 11 females wiht an average age of 42.5 years old ranging from 28 to 66 years. Among them,18 cases were odontoid process fractures,7 were congenital dissociate odontoid process,4 were Jefferson fracture combined with odontoid fracture,3 were rheumatic arthritis causing atlantoaxial instability. All patients suffered from the atlantoaxial subluxation and atlantoaxial instability. The JOA score ranged from 4 to 14 (means 9.1±0.3) before operation. The patients had some image examination including the X-ray of cervical vertebrae (include of dynamic position film),spiral CT 3D reconstruction and/or MRI. The position of pedicle screw system implantation,the angle of pedicle screw system implantation and screw length were measured. Operating skull traction. Operation undewent general anesthesia,implanted the pedicle screw,reduction and bone fusion under direct vision. The bone was fixated between posterior arch of atlas and lamina of axis by the lateral combination bended to posterior. Results:One hundred and twenty-eight atlantoaxial pedicle screws were implanted in 32 patients. No patient had the injure of spinal cord,nerve root and vertebral artery. All patients were followed-up from 6 to 48 months (averaged 16 months). After operation,the JOA score ranged from 11 to 17 (averaged 15.9±0.2),improvement rate was 86.1%. The fracture of odontoid process were healing completely. All fusion bone were combinated. The internal fixation wasn't loosening and breaking. Conclussion:The atlantoaxial pedicle screw system fixation was effective method to treat atlantoaxial instability. The method had many advantages,such as provide rigid and short segment fixation,safe and simple,high fusion rate. The method was worth in clinical application.