后路钉板寰枢关节、枕颈固定融合术

目的报告后路寰枢椎侧块、枕颈钉板固定融合术治疗寰枢椎不稳定的疗效。方法2006年1月至2007年12月,用特制螺钉及连接板固定寰枢椎、枕骨枢椎,治疗12例寰枢关节不稳定的患者。其中横韧带松弛3例,先天性齿突不连3例,寰椎骨折2例,齿状突粉碎骨折2例,寰枢椎脱位2例。结果本组12例获得5-28个月随访,平均16.3个月,均获得了骨性融合。没有神经、血管损伤和断钉、断板的病例。结论后路使用螺钉、固定板的寰枢关节、枕颈固定融合术具有短节段固定作用,不仅疗效可靠,而且便于寰枢关节复位。     

借助于枢椎椎板钉重建寰枢关节稳定的初步临床报告

目的 探讨以枢椎椎板置钉法完成寰枢或枕颈固定,用以治疗寰枢关节不稳的可行性.方法 对枢椎椎弓根畸形或椎动脉异位的病例以枢椎椎板置钉的方法 完成寰枢或枕颈固定.如果一侧枢椎椎弓根是大致正常的,就在该侧用椎弓根钉固定,在对侧用枢椎椎板钉固定.在寰椎以侧块螺钉固定,在枕骨以短螺钉固定.用连接棒在寰枢或枕枢间连接.在寰枢后弓间或枕骨与枢椎椎弓间植入颗粒状松质骨.结果 共完成了9个病例,其中寰枢固定2例,枕颈固定7例.使用一侧枢椎椎弓根钉固定、另一侧枢椎椎板钉固定6例,两侧均为椎板钉固定3例.9例均得到随访,随访时间4-13个月(平均9个月).所有病例均得到骨性融合.有神经症状的8例中,症状改善情况为:优3例,良1例,可2例,无变化2例.1例椎板钉进入了椎管.所有病例均没有出现脊髓和椎动脉损伤症状.结论 枢椎椎板置钉操作简便、安全,固定效果可靠.可以作为枢椎椎弓根置钉固定的后备方法 ,适用于椎弓根畸形或椎动脉异位的病例.     

颈前咽后入路病灶清除联合后路枕颈融合固定术治疗上颈椎结核

目的:探讨颈前咽后入路病灶清除联合后路枕颈融合固定术治疗上颈椎结核的临床效果。方法:2002年1月~2012年6月在我院接受手术治疗的上颈椎结核患者共21例,均伴有寰枢关节、寰枕关节严重破坏且寰椎侧块破坏无法置钉的11例,男7例,女4例,年龄40.4±9.5岁(26~54岁),寰椎结核4例,寰椎并枢椎结核7例,均行颈前咽后路病灶清除并一期后路枕颈融合内固定术。根据枢椎椎弓根破坏情况,2例采用双侧枢椎椎弓根螺钉固定,3例采用双侧椎板螺钉固定,6例采用一侧椎板螺钉和一侧椎弓根螺钉混合固定。术后应用抗结核药物治疗18个月,并随访其神经功能(JOA评分)、枕颈部VAS评分、植骨融合情况、复位程度及并发症。结果:11例患者平均随访39.5±13.1个月。术后9例获解剖复位,2例达部分复位;术后4个月10例达到骨性融合,1例出现部分植骨吸收,经对症治疗,于术后6个月获骨性融合。术后18个月结核病变均达到临床治愈。JOA评分由术前的8.4±1.3分上升到末次随访时的15.0±1.3分(P0.05),枕颈部疼痛症状也由术前的6.7±0.6分下降到末次随访时的0.64±0.6分(P0.05),围手术期及术后随访未发现严重的并发症。结论:采用经咽后入路病灶清除联合后路固定融合术治疗上颈椎结核临床疗效可靠,病灶清除彻底,内固定牢靠,是一种安全有效的治疗方法。     

重建钛板枢椎椎弓根螺钉及颗粒状植骨枕颈融合术

目的 探讨重建钛板螺钉及颗粒状自体松质骨植骨在枕颈融合中的应用。方法 2002年4月～2005年1月，选择枕颈区不稳定患者19例，年龄31～67岁；病程3个月～2年。其中枕寰枢椎复合畸形8例，陈旧性寰枢椎骨折脱位8例，类风湿性关节炎所致寰椎前脱位2例，枢椎齿状突肿瘤1例。JOA脊髓功能评分平均9．8分。使用重建钛板和枢椎椎弓根螺钉固定枕颈部，同时枕骨与枢椎后弓间颗粒状自体松质骨植骨。结果 术中、术后无并发症发生，切口Ⅰ期愈合。19例均获随访6个月～2年8个月，平均16个月，均获得了骨性融合。无神经血管损伤，无断钉、断板及内固定松脱。JOA脊髓功能评分平均达14．4分。结论 重建钛板枢椎椎弓根螺钉固定可靠，置入方便，自体颗粒状松质骨具有较高的融合率，在枕颈融合中效果满意。     

枢椎椎弓根钉板结合对侧椎板钉棒固定在寰枢椎及枕颈固定中的应用

目的探讨后路单侧枢椎椎弓根钉板系统结合对侧枢椎椎板钉棒系统在寰枢关节及枕颈固定中的临床疗效。方法后路单侧椎弓根钉板系统结合对侧枢椎椎板钉棒系统寰枢椎固定及枕颈固定11例,新鲜Ⅱ型齿突骨折5例,陈旧性齿突骨折3例,寰椎枕骨化畸形2例,寰枢椎不稳1例。单侧椎弓根发育狭小者6例,单侧椎动脉优势型2例,一侧椎动脉高跨2例,寰椎枕骨化畸形寰枢关节脱位行钉板系统固定失效后再次手术1例。寰枢椎固定9例,枕颈固定2例,1例难复型寰枢关节脱位行经口咽前路松解+后路复位内固定融合术,术后内固定失效行翻修手术。全部患者行后路寰枢或枕颈固定植骨融合术。比较术前、术后JOA评分变化,术后随访X线片及CT,观察寰枢椎复位及融合情况。结果所有患者均得到随访,随访时间6~32个月,平均16个月。全组患者无一例发生脊髓或椎动脉损伤,寰枢椎得到解剖复位,临床症状得到不同程度改善。术后JOA评分13~16分,平均14.9分,术前、术后JOA评分改善率为76%~92%,平均83%,术后半年复查CT显示均获得骨性融合,未见寰枢椎失稳或复位丢失征象,固定螺钉位置良好。结论单侧枢椎椎弓根钉板系统结合对侧枢椎椎板钉棒系统行寰枢关节及枕颈固定临床疗效可靠,但缺少临床对比研究。     

对颅骨牵引结合后路枕颈融合术治疗枕颈部畸形所致寰枢椎脱位的疗效评价

目的:探讨颅骨牵引结合后路枕颈融合术治疗枕颈部畸形所致寰枢椎脱位的临床疗效。方法:回顾性分析2004年1月~2011年6月收治的28例枕颈部畸形所致寰枢椎脱位患者,男18例,女10例;年龄13~56岁,平均31.1±14.2岁。颅底凹陷(扁平)畸形16例,其中8例伴寰椎枕骨化畸形,6例伴寰枢椎椎弓发育畸形,2例伴上述两种畸形;单纯寰椎枕骨化畸形6例;齿状突发育不良4例;单纯寰枢椎椎弓发育畸形2例。MRI示所有病例脊髓均有不同程度受压,术前JOA评分5~9分,平均7.2±1.4分。术前均行颅骨牵引,牵引重量4~7kg,平均5.2±0.7kg;牵引时间7~14d,平均10.1±2.1d;复查X线片,22例患者脱位部分复位,6例患者脱位完全复位。均行枕颈融合术,术中枢椎尽量置椎弓根螺钉(根据枢椎畸形程度,20例患者枢椎双侧置入椎弓根螺钉,6例单侧置钉,2例未能置钉),余固定节段(固定至畸形椎体下2~3个节段)置侧块螺钉。结果:全部病例手术均安全完成,手术时间3~5h,平均3.5h;术中出血量180~400ml,平均250ml;无脊髓、血管损伤及其他严重并发症。术后第1天JOA评分8~13分,平均10.6±1.5分,较术前明显改善(P<0.05)。术后复查X线片和MRI,21例患者脱位完全复位,7例患者脱位较术前明显改善,脊髓受压完全解除。随访6~48个月,平均20.3±9.7个月,所有病例术后3~6个月(平均4.3±0.9个月)获得骨性融合。末次随访时,JOA评分11~16分,平均14.6±1.7分,较术前及术后第1天均有改善(P<0.05)。随访期间内固定无松动、断裂。结论:颅骨牵引结合后路枕颈融合术治疗部分枕颈部畸形所致寰枢椎脱位近期疗效确切,安全可靠。     

枕骨钉结合枢椎椎弓根螺钉内固定术治疗寰枕融合并寰枢椎脱位

[目的]探讨单纯后路枕骨钉结合枢椎椎弓根螺钉内固定术治疗先天性寰枕融合并寰枢椎脱位的治疗效果。[方法]回顾性分析2008年4月~2013年12月本科收治的34例先天性寰枕融合并寰枢椎脱位患者的临床资料。采用单纯经后路枕骨螺钉和C_2椎弓根内固定,应用提拉撑开复位技术治疗此类畸形,术前及术后3、6个月及末次随访时行颈椎X线、枕颈区3D-CT、MRI检查,所有患者均根据术后影像学检查和日本骨科协会(Japanese Orthopedic Association Scores,JOA)评分评价影像和临床效果。[结果]随访9~38个月,平均16.5个月。患者症状有不同程度改善,无感染、死亡病例。术后影像学检查显示,所有患者复位满意,减压充分,且形成良好骨性融合。比较术前及术后随访时JOA评分和影像数据,结果示术前与术后末次随访时JOA评分及影像数据差异均有统计学意义(P0.05)。[结论]单纯后路枕骨钉结合枢椎椎弓根螺钉内固定提拉撑开复位技术,可以安全有效地治疗寰枕融合并寰枢椎脱位。     

改良植骨方法在后路寰枢关节和枕颈融合内固定术中的应用

目的:探讨改良植骨方法在寰枢关节和枕颈融合内固定术中的应用价值。方法:2011年1月~2013年1月,对32例因齿状突不连(21例)、寰椎横韧带断裂或松弛导致寰枢关节不稳(6例)以及颅底凹陷(5例)的病例,施行了后路经C1侧块或椎弓根螺钉和C2椎弓根或Magerl螺钉固定术(27例)或枕颈固定术(5例)。术中植骨时在C1和C2后弓或C2和枕骨间植入颗粒状松质骨,压实后将少许稍长的皮质骨条铺在表面,再放置明胶海绵2条,用可吸收线缠绕在两侧内置物上或缝合于两侧软组织上,形成网状结构,术后颈托固定,随访观察患者植骨融合情况。结果:所有患者均顺利完成手术。1例经口咽前路松解复位后路椎弓根螺钉内固定患者,出现术后咽后间隙感染,经积极抗感染治疗,于术后2周恢复。术中无内固定或植骨困难,术后随访未见复位丟失或假关节形成。32例均获得随访,时间5个月~3年2个月,平均19.1±7.2个月,全部患者手术后3~6个月获得骨性融合。结论:在寰枢关节和枕颈融合内固定术中应用改良植骨方法,可获得满意的融合率。     

钢板螺钉内固定在枕颈融合中的应用

目的探讨钢板螺钉内固定在枕颈融合中应用的疗效。方法1999年3月-2003年7月，应用钢板螺钉内固定枕颈融合治疗难以复位的寰枢椎脱位并脊髓压迫11例，其中齿突陈旧性骨折并寰椎前脱位7例，齿突发育不良并寰椎后脱位4例。结果寰枢椎脱位获得不同程度的复位，脊髓压迫解除，神经功能明显改善，枕颈部3～5个月骨性融合。结论对于难以复位的寰枢椎脱位应用钢板螺钉内固定枕颈融合术，不但固定较牢固可靠、简便，有利于植骨融合，而且还有一定的复位作用。     

侧块钉板固定器治疗寰椎前弓游离并寰枢关节不稳5例

目的探讨寰枢椎不稳后路手术治疗的一种方式。方法用北大第三医院王超教授设计的钛制寰枢椎侧块钉板固定器,改良的椎弓根钉螺钉和侧块钛板相结合治疗寰椎前弓游离并寰枢关节不稳5例。结果探所有螺钉均成功植入,复位固定满意。5例患者全部得到随访,随访12-24个月,平均21个月,均达到骨性愈合。没有神经、血管损伤,未发现螺钉松动、断钉和寰枢椎再移位病例。所有患者颈部前屈后伸及旋转功能良好,结果满意。结论探该型骨折并寰枢关节不稳后路选择寰枢椎侧块钉板固定使治疗变的安全、确切、稳定。     

Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems.

STUDY DESIGN: This retrospective study was conducted to analyze the clinical results in 26 patients with lesions at the craniocervical junction that had been treated by occipitocervical reconstruction using pedicle screws in the cervical spine and occipitocervical rod systems. OBJECTIVES: To evaluate the effectiveness of pedicle screw fixation in occipitocervical reconstructive surgery and to introduce surgical techniques. SUMMARY OF BACKGROUND DATA: Many methods of occipitocervical reconstruction have been reported, but there have been no reports of occipitocervical reconstruction using pedicle screws and occipitocervical rod systems for reduction and fixation. METHODS: Twenty-six patients with lesions at the craniocervical junction underwent reconstructive surgery using pedicle screws in the cervical spine and occipitocervical rod systems. The occipitocervical lesions were atlantoaxial subluxation associated with basilar invagination, which was caused by rheumatoid arthritis in 19 patients and other disorders in 7. The lowest cervical vertebra of fusion in 16 patients was C2, and the remaining 10 patients underwent fusion downward from C3 to C7. Flexion deformity of the occipitoatlantoaxial complex was corrected by application of extensional force, and upward migration of the odontoid process was reduced by application of combined force of extension and distraction between the occiput and the cervical pedicle screws. RESULTS: Solid fusion was achieved in all patients except two with metastatic vertebral tumors who did not receive bone graft for fusion. Correction of malalignment at the craniocervical junction was adequate, and postoperative magnetic resonance imaging showed improvement of anterior compression of the medulla oblongata. There were no neurovascular complications of cervical pedicle screws. CONCLUSIONS: Occipitocervical reconstruction by the combination of cervical pedicle screws and occipitocervical rod systems provided the high fusion rate and sufficient correction of malalignment in the occipitoatlantoaxial region. Results of this study showed the effectiveness of cervical pedicle screw as a fixation anchor for occipitocervical reconstruction.     

A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems

Purpose

To evaluate the effectiveness of posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems for patients with congenital osseous anomalies at the craniocervical junction.

Methods

Twenty patients with congenital osseous lesions who underwent posterior occipitocervical fusion using the anchors of cervical pedicle screws and plate-rod systems for reduction and fixation from 1996 to 2009 were reviewed. The lesions included os odontoideum, occipitalization of the atlas, congenital C2–3 fusion, congenital atlantoaxial subluxation, congenital basilar invagination and combined anomalies. The clinical assessment and the measurements of the images were performed preoperatively, postoperatively and at most recent follow-up.

Results

The combined deformity of flexion of the occipitoatlantoaxial complex and invagination of the odontoid process associated with congenital osseous lesions at the craniocervical junction was corrected by application of combined forces of extension and distraction between the occiput and the cervical pedicle screws. Preoperative myelopathy improved in 94.7 % patients. The mean Ranawat value, Redlund-Johnnell value, atlantodental distance, occiput (O)–C2 angle, and C2–C7 lordosis angle improved postoperatively and was sustained at most recent follow-up. The mean cervicomedullary angle improved from 129.3° preoperatively to 153.3° postoperatively. The mean range of motion at the lower adjacent motion segment remained unchanged at most recent follow-up. The fusion rate was 95 %.

Conclusions

The results of the present study indicate that posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems is an effective technique for treatment of deformities and/or instability caused by congenital osseous anomalies at the craniocervical junction.     

枕颈部后路不同内固定的生物力学比较

目的评价不同内固定重建枕颈部稳定性的生物力学性能。方法12具新鲜人体枕颈部标本,在标本完整、枕寰枢不稳、枕颈部植骨块钛缆固定(A组)、枕颈部经关节螺钉内固定(B组)、SUM-MIT枕颈部内固定系统固定(C组)五种状态下,依次用脊柱三维运动测量系统测试其OcC1、C1,2节段的运动参数。同时对固定后的OcC1经关节螺钉(OcC1TA组)、C1,2经关节螺钉(C1,2TA组)、枢椎椎弓螺钉(C2IS组)和枕骨螺钉(Oc Screw组)在生理载荷下三维六自由度运动时,运用电测法测定四种螺钉的拔出应力,并行统计学分析。结果在OcC1节段,B组在屈伸运动中的运动范围和中性区显著大于C组。在侧屈和旋转运动中,A组的运动范围和中性区均明显大于B、C组。在C1,2节段,B组各方向运动的运动范围和中性区均明显小于A组。B组在旋转运动中的运动范围和中性区均显著小于C组。电测法结果显示,侧屈状态下所有螺钉局部应变均接近0;前屈和旋转时螺钉承受不同程度的拉应力,后伸时螺钉承受压应力。Oc Screw组在屈伸和旋转运动状态下,所承受的任何载荷应力均大于其他三种置钉方法。结论枕颈部后路经关节螺钉内固定和SUMMIT枕颈内固定在控制旋转和侧屈的稳定性上有优点。枕骨螺钉承受的拉应力最大,生理环境下枕骨螺钉可能更易发生松动和断裂。     

枢椎棘突螺钉单侧应用联合对侧椎弓根螺钉固定的有限元分析

目的分析枢椎棘突螺钉单侧应用联合对侧椎弓根螺钉固定在寰枢和枕颈固定中的生物力学稳定性。方法构建正常枢椎解剖、椎板薄和椎动脉变异椎弓根细小3种不同解剖状态下的完整上部颈椎有限元模型作为完整模型组,然后分别模拟齿状突骨折进行寰枢固定和寰椎骨折进行枕颈固定。在寰枢固定中,比较单侧枢椎棘突螺钉+对侧椎弓根螺钉+双侧寰椎侧块螺钉固定组(棘突螺钉组)和枢椎双侧椎弓根螺钉+双侧寰椎侧块螺钉固定组(椎弓根螺钉组);在枕颈固定中,比较单侧枢椎棘突螺钉+对侧椎弓根螺钉+枕骨螺钉固定组(棘突螺钉组)和枢椎双侧椎弓根螺钉+枕骨螺钉固定组(椎弓根螺钉组)。枢椎棘突螺钉分别测试水平、斜向、垂直置钉3种不同的固定技术。模拟颈椎运动,测量枕颈的屈伸、侧屈、旋转的关节活动范围(ROM)。结果在寰枢和枕颈固定中,棘突螺钉组和椎弓根螺钉组的C1~C2屈伸、侧屈、旋转ROM均较完整模型组均明显下降。在寰枢固定中棘突螺钉组C0~C2屈伸、侧屈、旋转的ROM大于椎弓根螺钉组;在枕颈固定中,棘突螺钉组C1~C2侧屈的ROM大于椎弓根螺钉组,棘突螺钉组的C0~C2旋转的ROM大于椎弓根螺钉组。枢椎棘突螺钉分别测试水平、斜向、垂直固定间有差异,但不明显。结论在寰枢和枕颈固定中,枢椎双侧椎弓根螺钉固定和枢椎单侧棘突螺钉联合对侧椎弓根螺钉组合式固定方法均具有良好的稳定性。在寰枢固定中,相对于枢椎棘突螺钉组合式固定,枢椎双侧椎弓根螺钉固定具有更好的寰枢稳定性。在枕颈固定中,枢椎双侧椎弓根螺钉固定在侧屈和旋转活动上较枢椎棘突螺钉组合式固定稳定性更好。枢椎三种棘突螺钉置钉技术间的稳定性差异并不明显。     

Augmentation of occipitocervical contoured rod fixation with C1-C2 transarticular screws.

BACKGROUND CONTEXT: The technique of occipitocervical fusion using a threaded contoured rod attached with sublaminar wires to the occiput and upper cervical vertebrae is widely used throughout the world and has been clinically proven to provide effective fixation of the destabilized spine. However, this system has some disadvantages in maintaining stability, especially at C1-C2 because of the large amount of axial rotation at this level. In some clinical situations such as fracture of the C1 lamina, C1 laminectomy, and excessively lordotic curvature, it is not always possible to wire C1 directly into the construct. In such cases, combination of other stabilization methods that include C1 indirectly can be used to achieve a reliable posterior internal fixation. PURPOSE: Primarily, to evaluate whether a contoured rod construct in which C1 is indirectly included using C1-C2 transarticular screws is biomechanically equivalent to a standard, fully wired contoured rod construct. Secondarily, to evaluate the biomechanical benefit of adding C1-C2 transarticular screws to a fully wired contoured rod construct. STUDY DESIGN: Repeated-measures nondestructive in vitro biomechanical testing of destabilized cadaveric human occipitocervical spine specimens. METHODS: Six human cadaveric specimens from the occiput to C3 were studied. Angular and linear displacement data were recorded while nonconstraining nondestructive loads were applied. Three methods of fixation were tested: contoured rod incorporating C1 with and without transarticular screws and contoured rod with transarticular screws without incorporating C1. RESULTS: All three constructs reduced motion to well within normal range. In contoured rod constructs with C1 wired, addition of transarticular screws slightly but significantly improved stability. In constructs with transarticular screws, incorporation of C1 into the contoured rod wiring did not improve stability significantly. CONCLUSIONS: Adding C1-C2 transarticular screws to a wired contoured rod construct where C1 is included only slightly improves stability. As the absolute reduction in motion from adding transarticular screws is small (<1 degree), it is doubtful whether any enhanced fusion from this additional procedure outweighs the surgical risks. However, transarticular screws provide an effective alternate method to fixate C1 when the posterior arch of C1 is absent or has been fractured.     

板-棒-多轴螺钉系统后路枕颈固定疗效评价

[目的]报道板-棒-多轴螺钉系统后路枕颈固定的初步疗效，探讨与其它内固定比较的优势。[方法]14例接受颈枕Summit板-棒-多轴螺钉系统固定治疗，男9例，女5例。齿突发育不良并C1,2脱位3例，椎管肿瘤4例，C1,2转移癌并病理骨折、类风湿性关节炎并枕颈不稳与颅底凹陷症各2例，寰椎爆裂骨折并寰枢寰枕不稳1例。12例颈痛，13例有不同程度的脊髓损害表现，JOA评分平均12．4分。[结果]所有螺钉位置良好，无螺钉植入相关并发症。所有颈痛缓解。13例获随访，平均14个月。1例颈枕未融合，枕骨螺钉拔出，其它固定满意并坚固融合。神经功能均有不同程度恢复，JOA评分改善率为63．0％。[结论]板-棒-多轴螺钉系统后路枕颈固定安全可靠，取得了满意的临床疗效。与目前常用的固定方法比较具有一定优势。     

枢椎椎板螺钉固定与枢椎椎弓根螺钉固定对枕颈融合术临床疗效的影响

目的探讨经枢椎椎弓根螺钉与经枢椎椎板螺钉固定对枕颈融合术临床疗效的影响。方法选取2007年4月—2012年2月在本院行枕颈融合术的患者66例,回顾分析其临床资料、影像学资料以及随访资料。按照术式分为经枢椎椎弓根螺钉枕颈融合组(A组,37例)和经单侧枢椎椎板螺钉枕颈融合组(B组,29例)。对2组患者的颈髓角、日本骨科学会(JOA)评分、Odom功能分级以及寰枢关节复位情况进行分析比较。结果 2组患者术后随访26~56个月,平均37.6个月。术后1周及末次随访JOA评分与术前相比差异有统计学意义(P0.05),各时间点组间差异无统计学意义(P0.05)。2组患者术后1周颈髓角均有较大改善,与术前相比差异有统计学意义(P0.05);末次随访时2组患者颈髓角均有丢失,但与术后1周相比差异无统计学意义(P0.05);各时间点组间差异无统计学意义(P0.05)。术后3 d时A组解剖复位36例(97.3%),B组解剖复位27例(93.2%),差异无统计学意义(P0.05);末次随访时A组解剖复位丢失1例(2.7%),B组解剖复位丢失6例(20.7%),组间差异有统计学意义(P0.05)。末次随访时所有患者均骨性融合,随访过程中未发生严重并发症及后遗症。结论 2种融合方式均可取得满意的临床疗效,且对颈髓的减压充分。经椎弓根螺钉枕颈融合术可获得长期复位效果,是枕颈融合的首选术式。对必须采用经椎板螺钉枕颈融合的患者,术中应充分植骨,以增加复位的强度和稳定性。     

Posterior fixation and fusion with atlas pedicle screw system for upper cervical diseases

Objective： To evaluate the feasibility, safety and efficacy of atlas pedicle screws system fixation and fusion for the treatment of upper cervical diseases.
Methods： Twenty-three consecutive patients with upper cervical disorders requiring stabilization, including 19 cases of atlantoaxial dislocation （4 congenital odontoid disconnections, 6 old odontoid fractures, 4 fresh odontoid fractures of Aderson Ⅱ C, 3 ruptures of the C1 transverse ligament, and 2 fractures of C1）, 2 cases of C2 tumor （instability after the resection of the tumors）, and 2 giant neurilemomas of C2-C3（instability after resection of the tumors）, were treated by posterior fixation and fusion with the atlas pedicle screw system, in which the screws were inserted through the posterior arch of C1. The operative time, bleeding volume and complications were reported. All patients were immobilized without external fixation or with rigid cervical collars for 1-3 months. All patients were followed up and evaluated with radiographs and CT.
Results： In the 23 patients, 46 C1 pedicle screws, 42 C2 pedicle screws and 6 lower cervical lateral mass screws and 2 lower cervical pedicle screws were placed. The mean operative time and bleeding volume was 2.7 hours and 490 ml respectively. No intraoperative complications were directly related to surgical technique. No neurological, vascular or infective complications were encountered. All patients were followed up for 3-36 months （average 15 months）. Firm bony fusion was documented in all patients after 3-6 months. One patient with atlas fracture showed anterior occipitocervical fusion. There was no implant failure. Conclusions： Posterior fixation and fusion of the atlas pedicle screw system is feasible and safe for the treatment of upper cervical diseases, and may be applicable to a larger number of patients.     

改良枕颈融合术在上颈椎翻修手术中的应用

目的:探讨改良枕颈融合手术在上颈椎翻修手术中的应用。方法:2002年6月至2006年1月采用自行设计的枕骨板障螺钉联合颈椎椎弓根螺钉枕颈固定系统治疗11例上颈椎手术后因上颈椎不稳、残留颈髓压迫或肿瘤复发需再次手术的患者,其中9例患者获得随访,原发疾病包括先天性枕颈融合畸形3例,上颈椎肿瘤2例,上颈椎结核2例,颅底凹陷2例。术前和术后神经功能评价采用Frankel分级标准,根据术后当时以及随访时的X线片评价融合情况。结果:术中无神经、血管损伤。随访7～28个月,平均25个月,9例患者均获得了骨性融合,无断钉以及内固定失败等并发症。结论:枕骨板障螺钉联合颈椎椎弓根螺钉组成的枕颈固定器具有坚强的固定作用,是对常规枕颈融合手术的一种补充,适用于上颈段病变因第1次手术后导致上颈椎不稳、残留颈髓压迫需再次手术者,尤其适用于枕骨缺损、颅底骨质薄和骨质疏松的患者。