后路寰枢椎椎弓根螺钉固定治疗寰枢椎疾患

目的探讨后路寰枢椎椎弓根螺钉固定治疗寰枢椎疾患的手术可操作性和临床疗效。方法对68例寰枢椎脱位、骨折以及肿瘤或肿瘤样病变并有明显高位颈脊髓受压症状及体征的患者应用后路寰枢椎椎弓根螺钉固定技术治疗，术前均行X线、CT、MRI等影像学检查；术中在直视下行C1、C2置钉，复位固定，取髂骨椎板间植骨。术后颈托固定3个月。结果68例272枚螺钉均成功置入，复位固定满意。术后56例获3～27个月随访，平均13．8个月，患者均在3～6个月寰枢椎骨性融合，未发现螺钉松动、断钉和寰枢椎再移位现象。其中9枚螺钉穿入椎动脉孔内缘1mm，但无椎动脉损伤的临床表现。37例患者脊髓功能明显改善，11例好转，5例无明显改善，2例术后症状加重，1例死于术后并发症。结论经寰枢椎椎弓根螺钉内固定技术具有直视下置钉、短节段固定、术中复位、融合率高等特点，为寰枢椎疾患患者的治疗提供了一种较好的内固定术式。

Clinical Application of Pedicle Screw Instrument in Atlas and Axis

Objective To explore the surgical feasibility and clinical outcome of pedicle screw instrument in atlas and axis. Methods 68 cases with atlas and axis dislocation or atlas and/or axis fracture or tumors or look like tumors followed by upper cervical spinal cord compression symptom and body sign treated surgically with pedicle screw instrument via atlas and axis were reviewed. Preoperative CT, MRI and radiograph as well as intraoperative screw placement and ilium graft were administered in all cases. Cervical collars as external support were used. Results A total of 272 screws were successfully placed in atlas and axis. Of 68 cases, 56 cases were followed up from 3 to 27months（on an average of 13.8 months）. Bony fusion was observed in all 56 cases within 3 to 6 months without the complications of internal fixation failure and redislocation of atlas and axis. 9 screws penetrated into medial rim of the vertebral artery for 1mm,but no vertebral artery injury was documented. Neurological recovery was improved significantly in 37 cases, better in 11 cases, no change in 5 cases,worse in 2 cases, 1 case died of complication. Conclusion Pedicle screw instrument in atlas and axis has the advantages of direct screw placement,short-segment fusion, intraoperative reduction and high fusion rate, it is a better alternative for atlas and axis diseases.