带骨膜蒂枕骨外板翻转骨瓣在寰枢椎融合术中的应用

 目的评价带骨膜蒂枕骨外板翻转骨瓣在后路寰枢椎融合术中应用的可行性及其疗效。方法自2010年3月至2013年6月,对27例寰枢椎失稳患者在寰枢椎椎弓根钉棒系统内固定术中采用带骨膜蒂枕骨外板翻转骨瓣植骨融合,男16例,女11例;年龄23~56岁,平均45.6岁。12例新鲜齿状突骨折伴寰枢椎不稳（Anderson Ⅱ型9例、 Ⅲ型3例）,8例初次就诊时即有严重的骨折移位,4例轻度骨折移位行牵引复位、Halo-Vest支架固定后发生再移位;7例陈旧性齿突骨折伴寰椎前脱位（Anderson Ⅱ型5例、Ⅲ型2例）;先天性游离齿突7例;类风湿关节炎1例。采用疼痛视觉模拟评分（visual analogue scale,VAS）、Frankel分级评估术前与术后轴性颈痛和神经功能情况,采用正中矢状位CT观察植骨融合情况。结果所有患者均顺利完成手术,手术时间90~140 min,平均100 min。术中出血量100~600 ml,平均160 ml。术后随访18~39个月,平均32.6个月。骨性融合时间3个月19例、6个月7例、9个月1例。VAS 评分由术前（7.23±1.65）分降低到末次随访的（2.87±1.03）分,差异有统计学意义。术前9例存在脊髓神经功能损害者末次随访时7例恢复至完全正常,2例术前Frankel分级C级末次随访时恢复至D级。术中损伤椎旁静脉丛1例,使用明胶海绵及脑棉片行压迫止血。术后复查CT提示1例患者寰椎左侧椎弓根螺钉位置偏外,1例患者枢椎左侧椎弓根螺钉位置偏外,均紧邻横突孔,但此2例患者均无临床症状,未予以特殊处理。结论带骨膜枕骨外板翻转骨瓣植骨是寰枢椎固定植骨融合的有效方法之一,具有可行性及安全性。

Clinical application of flipping periosteum pedicle occipital outer plate for atlantoaxial fusion

ObjectiveTo evaluate the feasibility and efficacy of atlantoaxial fusion by flipping periosteum pedicle occipital outer plate. MethodsBetween March 2010 and June 2013, 27 patients with atlantoaxial instability were treated by atlantoaxial fusion with flipping periosteum pedicle occipital outer plate and combining pedicle screws fixation. There were 16 males and 11 females with the age ranging from 23 to 56 years (with an average of 45.6 years) at time of surgery. There were 12 cases of fresh odontoid fracture with atlantoaxial instability, 7 cases of old odontoid fracture combined with uneducable atlantoaxial dislocation, 7 cases of congenital loose of odontoid process, and 1 case of rheumatoid arthritis. The visual analog scale (VAS) scores and Frankel grades were respectively used to evaluate the axial neck pain and the neurological deficit, and the results were compared before and after the operation. Bony fusion was observed by the midline sagittal CT scan images. ResultsAll the patients were successfully operated. The operation time was 90 to 140 mins (with an average of 100 mins), and the blood loss was 100 to 600 ml (with an average of 160 ml). All patients were followed up for 18 to 39 months, with an average of 32.6 months. 19 cases got solid fusion 3 months after surgery, and 7 cases got solid fusion 6 months after surgery, while 1 case got solid fusion 9 months after surgery. The average VAS score at final follow-up was 2.87±1.03, which was significantly lower than that preoperatively 7.23±1.65. Before the operation, nine cases presented spinal nerve function damage. At the final follow up time, 7 cases returned to complete normal and 2 cases improved from grade C to grade D according to the Frankel classification. 1 case was complicated with veiniplex injury with no heavy blood loss, due to successful hemostasia. Two screws were placed close to the vertebral artery canal,without clinical consequences. ConclusionThe flipping periosteum pedicle occipital outer plate as a bone graft is one effective method for atlantoaxial fusion, which got great feasibility and safety.