寰枢椎不稳的颈后路手术治疗

目的 对寰枢椎不稳的颈后路手术治疗进行探讨。方法 共78例患者，男57例，女21例；年龄3－78岁，平均42岁。其中齿突骨折（新鲜骨折、陈旧骨折、骨不连）38例，齿突游离小骨15例，寰椎横韧带断裂8例，寰枢椎肿瘤6例，枕颈部发育畸形6例，寰椎椎弓陈旧性骨折5例。78例均行颈后路手术，包括枕颈融合术32例，其中单纯植骨融合11例，辅以CD－Cervical内固定11例，Cervifix内固定10例；寰枢椎融合术46例，其中钢丝钛缆内固定37例（9例同时行寰枢椎经关节间隙螺钉内固定术），Apofix椎板夹内固定9例。结果 78例均获随访，时间6个月－18年，平均38．4个月。骨性愈合75例，不愈合3例。术前合并神经系统症状38例，术后症状消失或基本消失20例，明显改善11例，轻度改善3例，无改善2例，加重2例。结论 对于由寰枢椎骨折脱位、畸形、肿瘤及横韧带断裂等引起的寰枢椎不稳，应早期进行后路融合术。充分控制寰枢椎活动，精心准备植骨床是保证手术成功的关键。

Posterior surgical approach for operation of atlantoaxial instability

Objective To investigate the results of surgical treatment of atlantoaxial instability through posterior approach. Methods Seventy eight patients with atlantoaxial instability were used for this collective review, the patients included 38 with unstable odontoid fractures,15 with os odontoideum,8 with a disrupted transverse ligament, 6 with C1,2 tumor,6 with congenital occipitocervical abnormalities,5 with old Jefferson fractures. There were 57 males and 21 females. The mean age of the patients was 42 years(range, 3-78 years). All patients were treated by operation. Thirty seven patients were operated upon by atlantoaxial arthrodesis using wire fixation with autologous bone grafts. Nine were treated by C1,2 posterior wiring fixation and atlantoaxial facet screw fixation. Nine were operated on by atlantoaxial arthrodesis using Apofix interlaminar clamping with autologous bone grafts. Occipitocervical fusion was performed in 32 patients, arthrodesis simple with autologous bone grafts and external fixation was done in 11 patients. CD-Cervical fixation was used in 11 patients. Cervifix fixation was used in 10 patients. Results The patients were followed up for an average of 38.4 months(range, 6-216 months). Solid arthrodesis was obtained in 75 patients and non union in 3 cases. All the non union cases occurred after occipitocervical fusion. Conclusion Posterior fusion is recommended for atlantoaxial instability due to traumatic fracture or ligament disruption, tumor, inflammatory, skeletal dysplasias, congenital abnormalities. It is emphasized that adequately controlling atlantoaxial motion, meticulously preparing the fusion bed are the important measures for successful operation.