多种寰枢椎后路钉棒固定技术的临床组合应用

目的评价3种寰椎后路螺钉固定方法和2种枢椎后路螺钉固定方法构成的钉棒组合治疗上颈椎不稳的可行性和临床效果。方法在气管插管全麻下对132例患者施行了寰枢椎后路钉棒固定技术,寰椎进行椎弓根螺钉、部分经椎弓根螺钉或侧块螺钉固定;枢椎进行椎弓根螺钉或交叉椎板螺钉固定。结果全组病例获钉棒固定,其中寰椎螺钉固定采用椎弓根螺钉224枚,部分经椎弓根螺钉36枚,侧块螺钉4枚;枢椎螺钉固定采用椎弓根螺钉240枚,椎板螺钉24枚。术中未发生椎动脉、脊髓损伤。120例患者术后获得随访3～22个月,平均8个月,临床症状得到不同程度的改善;X线片、CT复查螺钉位置良好,无松动、断钉,植骨3～6个月后均达到满意融合。结论寰椎和枢椎螺钉可进行多重组合,为上颈椎后路提供灵活多变的短节段固定,增加了钉棒固定技术的临床适用范围。

The clinical combination of multi C1-C2 screw-rods fixation techniques in atlantoaxial instability

Objective To evaluate the feasibility and clinical effects of the combination of 3 kinds of C1 posterior screw fixation methods with 2 kinds of C2 posterior screw fixation methods in atlantoaxial instability.Methods Under general anesthesia,132 patients with atlantoaxial instability were treated by C1-C2 screw-rods fixation techniques which C1 screw fixation methods including pedicle screw,partial trans-pedicle screw and lateral mass screw,while C2 screw fixation methods including pedicle screw and translaminar screw.Results All cases got C1-C2 screw-rods fixation,including 224 C1 pedicle screws,36 C1 partial trans-pedicle screws and 4 C1 lateral mass screws;240 C2 pedicle screws and 24 C2 translaminar screws.No neural or vascular injuries occurred during the operations.One hundred and twenty cases were followed up for 3 to 22 months,averaged 8 months.The clinical symptoms were improved to some extent in all patients,and the postoperative radiological results of X-ray and CT scans verified that all C1 screws and C2 screws had good positions.No cases of implant failure were found,and all patients had solid bone fusions 3 to 6 months after surgery.Conclusion C1 and C2 screws can be used to combine flexible multi screw-rod groups for atlantoaxial mono-segment fixation which can expand the clinical applicability scope of screw-rod fixation techniques.