个体化设计解剖定位椎弓根镙钉置入内固定治疗寰枢椎不稳

背景：经寰枢椎椎弓根螺钉置入内固定常用于治疗寰枢椎不稳。但是，目前寰枢椎椎弓根螺钉的进钉点和进钉角度多以统计处理的解剖数据确定，解剖差异的存在使目前置钉方法难以保证椎弓根螺钉准确置入到每一例患者。 目的：评估个体化设计解剖定位寰枢椎椎弓根螺钉置入内固定技术治疗寰枢椎不稳的安全性和可靠性。 方法：对16例寰枢椎不稳患者分别以术中寰椎椎弓根下壁、内侧壁以及枢椎上壁、内侧壁为定位依据，结合置入前影像学测量确定寰、枢椎椎弓根镙钉的进钉点、进钉角度以及镙钉长度，置入寰、枢椎椎弓根螺钉内固定系统。 结果与结论：16例患者均成功置入螺钉，置入后X射线片及CT显示寰枢椎椎弓根螺钉位置良好。置入后随访9~24个月，所有患者均获得骨性融合、症状改善，置入后脊髓功能改善优良率为84.6%，其中优6例(46.2%)，良5例(38.5%)，可2例(15.4%)，无神经血管损伤等并发症发生。提示个体化设计解剖定位寰枢椎椎弓根螺钉置入内固定治疗寰枢椎不稳的进钉点和进钉角度定位准确，螺钉置入安全、可靠。 关键词：寰枢椎不稳；椎弓根螺钉；个体化设计；解剖定位；植入体 doi:10.3969/j.issn.1673-8225.2012.09.026 

Technology of pedicle screw implantation by individual design and anatomical localization for treatment of atlantoaxial instability

BACKGROUND: The pedicle screw internal fixation is usually used for treatment of atlantoaxial instability. The implanted location and angulation of these pedicle screws are statistically determined by anatomy data. But this method always leads to inaccurate implant of the screw into the injured atlantoaxial. OBJECTIVE: To evaluate the security and reliability of pedicle screw implantation by individual design and anatomical localization for treatment of atlantoaxial instability. METHODS: A total of 16 cases with atlantoaxial dislocation were fixed with atlantoaxial pedicle screw by location through inferior and inner wall of atlas and superior and inner wall of axis. Combined with the first image measurement, the implanted location, angulation and screw length of atlas were determined, and pedicle screw fixation system was implanted. RESULTS AND CONCLUSION: All the 16 patients were implanted successfully with atlantoaxial pedicle screw. The post-implantation X-ray film and CT image showed the position of pedicle screw was well. They were followed up for 9 to 24 months after the operation. All of them obtained bony union with improved function of the spinal reached 84.6% which containing excellent in 6 cases (46.2%), good in 5 cases (38.5%) and moderate in 2 cases (15.4%). No aggravation was observed, and no complications such as vascular injury, either. It indicates that pedicle screw implantation by individual design and anatomical localization for treatment of atlantoaxial instability has the characteristics of accurate implanted location and angulation, and the security and reliability of pedicle screw implantation.