Apofix椎板钩在寰枢椎不稳治疗中的应用

目的探讨Apofix椎板钩在寰枢椎不稳治疗中的价值和作用。方法对8例寰枢椎不稳患者行寰枢椎后路融合，并采用Apofix椎板钩内固定。结果随访6～28个月，所有病例均获得骨性愈合。结论Apofix椎板钩操作安全，可提供有效的寰枢椎节段稳定性，适用于寰枢椎不稳患者的治疗。术前解剖复位是手术成功的关键。     

牵引引推拿治疗环枢椎半脱位

自1986年以来，我们采用杭颌带悬吊牵引配合推拿手法治疗环枢椎半脱位32例，疗效满意总结报告如下。临床资料本组32例中男性23例，女性9例；年龄最大19岁，最小8岁；均为外伤所引起。症状及体征外伤突然发病，颈部无明显肿胀，环枢椎部压痛明显，颈部呈僵硬状态，屈伸旋转受限，双上肢运动尚可，皮肤感觉正常，双侧霍夫曼氏征阴性，臂丛牵拉试验阳性者5例，左手握力减弱者18例，右手握力减弱者14例。X线检查显示，侧位片见颈椎生理曲度消失，正位片（开口像）见环枢椎呈侧方半脱位，余骨质无异常改变。治疗方法①牵引：患者坐位，行杭颌带…     

双侧经寰枢椎关节螺钉联合寰椎椎板挂钩固定术治疗寰枢椎不稳

目的 探讨寰枢椎不稳的手术治疗方法 .方法 采用双侧经寰枢椎关节螺钉联合寰椎椎板挂钩固定及取自体髂骨植骨融合的方法 治疗寰枢椎不稳患者15例,并进行回顾分析.结果 15例患者均术中顺利,未发生并发症,术后均症状缓解、功能恢复,经6～24个月随访,平均12.3月,均获得骨性愈合,无一例假关节形成,取得满意疗效.结论 双侧经寰枢椎关节螺钉联合寰椎椎板挂钩固定植骨融合术具有安全、术后即刻稳定、植骨融合率高等特点,为寰枢椎不稳后路的理想术式.     

Apofix椎板钩治疗创伤性寰枢椎不稳

目的 评价Ａｐｏｆｉｘ椎板钩治疗创伤怀寰枢椎不稳的效果。方法 对创伤性寰枢椎不稳患者行Ｃ１－２后路融合、Ａｐｏｆｉｘ椎板钩内固定术。包括齿状突骨折５例,其中１例伴横韧带断裂。结果 术后随访３￣１１个月,颈椎侧位Ｘ线片检查,５例获骨性愈合。结论寰枢椎后路融合,Ａｐｏｆｉｘ椎板钩内固定术适于治疗创伤笥寰枢椎不稳;解剖复侠是手术成功的主要。     

寰枢椎不稳的诊断和治疗

本文报告18例寰枢椎不稳,其中寰枢椎先天性发育不良6例,寰枢椎自发性脱位2例,寰枢椎结核1例。陈旧性齿状突骨折2例,新鲜骨折4例,寰、枢椎椎弓骨折各1例,横韧带损伤1例。4例采用非手术治疗,14例施行手术治疗,其中寰枢椎融合7例,枕颈融合6例,枕大孔减压枕颈融合1例。平均随访2年10个月,18例寰枢椎都获得稳定,其中9例脊髓受压者脊髓功能都恢复正常,本文就临床征象、诊断和治疗方法作了讨论。     

寰枢椎脱位与不稳的外科治疗进展

寰枢椎脱位与不稳在临床上较为常见,危害性或潜在危害性大,外科治疗较为复杂和棘手。近些年来,随着对颅颈交界区生物力学认识的深入和一些新的内固定器材的出现与应用,治疗方法和手段不断改进和完善,疗效逐步提高。本文就寰枢椎脱位与不稳的外科治疗原则、治疗指征以及常用的治疗方法作一文献综述。1　病因、病理与分类寰枢椎脱位与不稳的病因可分为先天性、外伤性和病理性3大类。先天性寰枢椎脱位与不稳最常见的原因为齿突畸形,包括齿突缺如、齿突发育不全和齿突分离3种类型。在寰枕融合或ＫｌｉｐｐｅｒＦｅｉｌ综合征或颅底凹陷患者,寰枢…     

小儿寰枢椎不稳的手术治疗

目的 探索一套手术治疗小儿寰枢帷不稳的方法。方法 对３１例１５岁以下的寰枢椎不稳的患儿进行手术治疗。先借助头环背心（ｈａｌｏ－ｖｅｓｔ）使寰椎复位并获得稳定。对１７例患儿施行颗粒状自体松质骨植骨的寰枢椎后路融合术,３例行寰椎后弓切除枕颈融合术,５例行枕骨大孔开大枕颈融合术,６例单纯行枕颈融合术。结果 全部病例均获植骨融合。头环背心平均固定时间：枕颈融合术者９４．３ｄ,寰枢椎融合术者６８．５ｄ。有脊     

寰枢椎不稳或脱位的诊断与治疗

头部和颈椎在遭受强的外力作用下可发生急性寰枢椎脱位 ,使颈髓和延髓受压 ,引起致死性损伤。对因各种非外伤性疾患所致的寰枢椎脱位 ,近年来也逐渐有所认识。在名称上也有称“寰枢椎脱臼”或“寰枢关节脱臼 (ａｔｌａｎｔｏ ａｘｉａｌｄｉｓｌｏｃａｔｉｏｎ)”、“寰枢椎半脱臼 (ａｔｌａｎｔｏ ａｘ ｉａｌｓｕｂｌｕｘａｔｉｏｎ)”或者称“寰枢椎关节不稳定 (ａｔｌａｎｔｏ ａｘｉａｌｉｎｓｔａｂｉｌｉｔｙ)” ,但使用“寰枢椎脱位”者较多。按其脱位的方向 ,有向前方脱位、向后方脱位、旋转脱位、侧方脱位 (罕见 )及垂直脱位 (类…     

寰枢椎畸形并不稳的治疗（附73例分析）

目的：探讨寰枢椎畸形并不稳的临床及其治疗方法。方法;对73例因寰枢椎先天性畸形导数上颈椎不稳患者分别施行保守及手术治疗,其中保守治疗21例,手术治疗52例。结果：保守治疗患者随访3个月至2年,其中14例患者症状缓解或无加重,另7例因症状加重行手术治疗。手术治疗患者随访3个月至10年,效果均满意。结论：对于有症状的寰枢椎畸形并不稳患者可采取积极手术治疗,复位、减压及重建稳定性是治疗之原则。     

寰枢椎不稳后路融合术治疗进展

寰、枢椎不稳可因创伤、炎症、局部畸形、肿瘤等引起,包括齿突骨折、寰椎椎弓骨折、枢椎椎弓骨折以及因此造成的寰椎脱位等,易致颈脊髓受压,甚至威胁患者的生命。在治疗方法上,过去以保守治疗为主,如颅骨牵引、Halo支架、头颈胸石膏等。近年来,越来越多数学者提倡手术治疗,在手术方式和治疗效果上已取得很大进展。常见的颈后路手术方法包括枕颈融合术、寰椎后弓切除术和寰枢椎融合术。从生物力学的角度来看,寰枢椎融合术更为合理、有效,对颈部旋转功能限制相对较小。本文就寰枢椎后路融合术作一综述。1　手术方法1.1钢丝或钛缆　Mixter和O…     

Interlaminar Atlanto-Axial Fusion for Instability

At the Departments of Neurosurgery and Orthopaedic Surgery in Odense 36 patients were treated with atlanto-axial interlaminar fusion. The operation was performed jointly by the neurosurgeon and orthopaedic surgeon, working as a team, using a specially developed technique. Two bone grafts from the iliac crest were shaped, with grooves for the two laminae, and fixed with wire on the right and left side. Postoperative immobilization in a Minerva jacket was maintained for 3 months and a plastic collar was worn for another 3 months.

Twenty-one patients had odontoid fractures, five of them with pseudarthrosis. Ten had atlanto-axial instability caused by rheumatoid arthritis. The instability was horizontal in seven cases, with a mean distance of 12 mm from the odontoid process to the anterior arch of the atlas. Five patients had vertical dislocation with the apex of the odontoid process protruding 8 mm (mean) cranially to the foramen magnum, and eight had cord signs. Two patients had an os odontoideum with instability after trauma, and three had other lesions.

At follow-up, at least 1 year after the operation, all fusions were solid, and all fractures but one had healed. The rheumatoid patients had achieved great relief of symptoms with minimum restriction of movement in the cervical spine. The indications for operation on patients with rheumatoid arthritis are very restrictive.     

Interlaminar Atlanto-Axial Fusion for Instability

At the Departments of Neurosurgery and Orthopaedic Surgery in Odense 36 patients were treated with atlanto-axial interlaminar fusion. The operation was performed jointly by the neurosurgeon and orthopaedic surgeon, working as a team, using a specially developed technique. Two bone grafts from the iliac crest were shaped, with grooves for the two laminae, and fixed with wire on the right and left side. Postoperative immobilization in a Minerva jacket was maintained for 3 months and a plastic collar was worn for another 3 months.

Twenty-one patients had odontoid fractures, five of them with pseudarthrosis. Ten had atlanto-axial instability caused by rheumatoid arthritis. The instability was horizontal in seven cases, with a mean distance of 12 mm from the odontoid process to the anterior arch of the atlas. Five patients had vertical dislocation with the apex of the odontoid process protruding 8 mm (mean) cranially to the foramen magnum, and eight had cord signs. Two patients had an os odontoideum with instability after trauma, and three had other lesions.

At follow-up, at least 1 year after the operation, all fusions were solid, and all fractures but one had healed. The rheumatoid patients had achieved great relief of symptoms with minimum restriction of movement in the cervical spine. The indications for operation on patients with rheumatoid arthritis are very restrictive.     

Os Odontoideum: A Cause of Atlanto-Axial Instability

Os odontoideum is a rare condition in which instability may damage the upper cervical cord. A delay in diagnosis is not uncommon. This paper describes a series of 11 patients with os odontoideum. The presenting symptoms were divided into three groups: posttraumatic neck-pain, gradually appearing signs of medullary compression and an asymptomatic group. Eight patients had atlanto-axial instability. Six had interlaminar fusion between atlas and axis. No serious complications were seen. Stability was obtained in all patients postoperatively. In case of significant instability, fusion is indicated. In patients with cerebral palsy a closer examination of the upper cervical cord is recommended.     

寰枢椎内固定对陈旧齿状突骨折的作用

目的:观察陈旧齿状突骨折患者在后路寰枢椎坚强内固定融合术后骨折端的变化,探索采用寰枢椎非融合内固定治疗齿状突骨折、尤其是新鲜骨折的可行性。方法:对我院2001年2月~2012年8月采取后路寰枢椎固定融合术治疗的82例陈旧性齿状突骨折患者手术前后的影像资料进行回顾性分析。其中2005年1月~2012年8月42例有完整的术前、术后CT资料可供分析骨折端变化的患者作为研究对象,伤后手术时间3~8周5例、8周以上~36周30例、36周以上7例,40例选择经寰椎侧块-枢椎椎弓根内固定、寰椎后弓枢椎椎板间植骨融合术,2例选择经寰枢侧块关节螺钉固定融合术,术后随访时间截至寰枢间植骨融合为止。结果:所有患者寰枢椎间后方植骨发生融合,其中30例齿状突骨折也发生愈合,4例疑似愈合,8例未愈合。齿状突骨折端愈合时间:28例发生于术后4个月,1例发生于术后6个月,1例发生于术后9个月。结论:对陈旧齿状突骨折患者经后路寰枢椎间内固定可为齿状突骨折愈合提供可靠的稳定性,为采用非融合寰枢椎内固定治疗齿状突骨折尤其是新鲜骨折提供了可靠的临床依据。     

经皮前路侧块螺钉内固定植骨融合治疗C1,2不稳

目的　创建一种经皮前路侧块螺钉内固定植骨融合治疗C1,2 不稳的手术方法。方法　取 4 0名正常人影像学测量寰枢椎正位、侧位片的标准角、安全角、椎动脉内壁至寰椎上下缘中点连线的距离等相应数据 ,并用自行研制手术器械 ,对 15例C1,2 创伤性不稳的患者。男 10例 ,女 5例 ;寰枢椎 (半 )脱位 7例 ,陈旧齿状突骨折伴脱位 1例 ;Jefferson骨折 3例 ;C1前弓骨折 4例。在C臂X光机监视下行经皮前路侧块螺钉内固定前路植骨融合技术治疗 ,并分析其治疗结果。结果　正位片上其标准角右侧为 2 4 0°± 3 7° ,左侧为 2 3 8°± 1 8°;安全角右侧为 15 2°～ 30 3° ,左侧为 14 8°～ 32 1°;椎动脉内壁至寰椎上下缘中点连线的距离右侧为 (5 6± 2 2 )mm ,左侧为 (5 8± 1 9)mm ;侧位片的标准角为 2 4 1°± 1 8° ;安全角为 12 6°～ 2 6 8°。 15例患者内固定均获得了满意效果 ,螺钉位置佳。无脊髓、椎动脉和食管损伤等并发症发生。穿刺创口无感染。结论　经皮前路侧块螺钉内固定治疗C1,2 不稳操作简单 ,出血少 ,创伤小 ,恢复快 ,可一期行侧块关节固定植骨融合。手术有一定风险 ,如使用合理的配套器械 ,并熟悉其解剖特点 ,在X线透视下正确选择进针点、角度和深度 ,操作规范 ,此技术是安全的。     

Evolving Concepts in the Management of Shoulder Instability

BackgroundShoulder instability exists on a spectrum ranging from subtle subluxation and pain to dislocation and can be the result of a traumatic event or repetitive microtrauma. Shoulder instability can result in significant disability and often requires surgical intervention, especially amongst younger, active patient populations. The optimal treatment of shoulder instability depends on the degree of instability and concomitant pathology involving the labrum, capsule, and bony anatomy of the glenoid and humeral head. Even with surgical intervention, recurrent instability remains a relatively common and difficult problem to address.PurposeWith a focus on anterior instability, the purpose of this review article is to discuss the current assessment and treatment of shoulder instability, and highlight current and future treatment modalities, as well as to identify current trends and deficiencies in our current management. We also provide an algorithm for the surgical treatment of anterior shoulder instability.MethodsLiterature databases were extensively searched for recent articles related to the mechanism, diagnosis, and treatment of shoulder instability to comprise a comprehensive review.Conclusion Although there are multiple treatment modalities available for shoulder instability, such as nonoperative management, open and arthroscopic Bankart repair, Latarjet procedures, and remplissage, orthopaedic surgeons continue to learn about the most appropriate method of management as increasing long-term outcomes become available.