寰枢椎椎弓根钉板固定融合治疗上颈椎伤病临床体会

目的]探讨经寰枢椎椎弓根钉板固定融合治疗上颈椎伤病的临床疗效。方法]回顾2000年3月~2007年9月,徒手对50例上颈椎伤病患者进行后路经寰枢椎椎弓根钉板系统复位内固定,置入200枚寰枢椎椎弓根钉,在寰椎后弓及枢椎椎板间植骨融合,使寰枢椎复合体得到稳定。其中男36例,女14例;年龄20~65岁,平均41.52岁。Ⅱ型齿状突陈旧性骨折23例,齿状突不连12例,横韧带损伤15例。结果]4例术后出现枕大神经痛,经对症治疗1个月后痊愈;2例螺钉穿破寰椎左侧椎弓根外侧壁,未发现脊髓、椎动脉损伤。48例获得随访,随访时间25~60个月,平均27.56个月,均获得骨性融合,未发现钉板断裂。所有患者X线片示寰椎完全复位,枢椎齿状突骨折处复位良好。CT片示螺钉与椎动脉及脊髓位置关系良好。按JOA评分标准,优34例,良13例,可2例,差1例;优良率94.00%。结论]寰枢椎椎弓根螺钉结合钉板系统固定治疗上颈椎伤病,能显著增强寰枢椎间生物力学稳定性,植骨融合率高,该术式在寰枢椎融合术中具有较高的推广应用价值。

Atlanto-axial pedicle screw plate and fusion in treatment of upper cervical injuries

Objective]To investigate the effect of atlanto-axial pedicle screw plate and fusion in treatment of upper cervical injuries. Methods]Fifty-six cases of upper cervical spine injuries were treated with atlanto-axial pedicle screw plate and internal fixation,with total 200 screws,from March 2000 to September 2007.There were 36 males and 14 females,with an average age of 41.52 years(ranged,20~65 years).There were 23 cases of type II odontoid process fracture,12 cases of odontoid process nonunion,15 cases of t...