经后路寰枢椎椎弓根螺钉侧块固定治疗寰枢不稳或脱位疗效观察

目的 评价后路寰枢椎椎弓根螺钉侧块固定治疗寰枢不稳或脱位的临床疗效.方法 2005年5月至2008年1月,共收治各种原因引起的寰枢椎不稳或脱位患者31例,其中男性23例,女性8例;年龄17～67岁,平均43.5岁.寰枢椎不稳或脱位原因有:齿状突陈旧性骨折17例,游离齿状突8例,齿状突骨折4例,横韧带断裂1例,类风湿关节炎1例.31例患者均有枕颈痛表现,28例有颈椎活动受限,19例有不同程度颈髓受压症状和体征.所有病例均行后路寰枢椎椎弓根螺钉复位固定.记录患者手术时间、失血量和并发症发生情况;同时对手术前后有关临床疗效指标和影像学资料进行对比评价及统计学分析.结果 31例患者平均手术时间2.5 h,平均出血量300 ml.术后均获随访,随访时间6～37个月,平均13个月.1例患者术后出现切口感染,通过调整抗菌素和切口换药2周后得到控制;1例患者术后第5天出现肺动脉栓塞(经肺动脉造影证实),经抗凝等治疗2个月后康复.术中无椎动脉损伤,术后无C_2神经分布区疼痛或麻木病例.31例患者术前存在的枕颈部疼痛均减轻.19例颈脊髓损伤症患者末次随访脊髓功能JOA评分与术前相比明显提高(P<0.01).31例末次随访动态X线片未见寰枢椎移位,无内固定物断裂或松动;CT三维重建有2例患者寰枢椎后弓间骨小梁连续性中断.总融合率达93.6%.结论 后路寰枢椎椎弓根螺钉侧块固定具有直视下置钉、术中复位、良好的三维短节段固定等优势,是良好的寰枢椎后路固定融合技术.

Outcomes of posterior C_(1-2) fusion for atlantoaxial instability or dislocation using pedicle screws of atlas and axis

Objective To retrospectively analyze and evaluate the results of treatment for atlantoaxial instability or dislocation employing pedicle screws of atlas and axis.Methods Thirty-one patients(23 male and 8 female) with atlantoaxial instability or dislocation were stabilized using pedicle screws of atlas and axis between May 2005 to January 2008.The patients ranged in age from 17 to 67 years (mean 43.5 years).Patients consisted of chronic odontoid fracture in 17,Os odontoideum in 8,fresh odontoid fracture in 4,transverse ligament rupture in 1,rheumatoid arthritis in 1.Clinical features included neck pain in 31; restricted neck movement in 28,varying degrees of spastic quadriparesis in 19.All patients underwent posterior C_1 to C_2 pedicle screw fixation.Operative time,intraoperative blood loss,complications were recorded,neurological and radiographic studies were carried.Results Mean follow-up time was 13months.Operative time averaged 2.5 h.Mean intraoperative blood loss was 300 ml.A patient had postoperative wound infection and was treated conservatively with antibiotics and local woundcare.A patient developed pulmonary artery embolism and got well with anticoagulation- Satisfactory stability was achieved in all cases with no vascular and C_2 neuralgia.Average JOA score in 19 cases increased at final follow-up (P<0.01).Solid fusion was achieved in 29 cases,fusion rate was 93.6%.Conclusions Stabilizaion of atlantoaxial complex via pedicle screws of atlas and axis has advantages of intraoperative restoration,easier placement of screw,solid fixation.It is a safe and effective treatment modality for posterior C_(1-2) fusion.