后路寰枢椎弓根钉棒系统固定融合治疗上颈椎不稳

目的 探讨和评估寰枢椎椎弓根钉棒系统固定融合治疗上颈椎不稳的临床疗效、适应证及应用价值.方法 2006年5月至2010年12月,采用寰枢椎椎弓根螺钉技术治疗上颈椎不稳患者24例,男18例,女6例,其中齿突发育不良造成的寰枢椎不稳5例,顽固性寰枢椎旋转脱位4例,创伤性陈旧性寰枢关节脱位6例,椎管内肿瘤4例,陈旧性齿突骨折5例,24例均采用美国强生Depuy公司生产的后路Summit钉棒系统(万向螺钉直径3.5mm,寰椎螺钉长26 ～30 mm,平均28 mm,枢椎螺钉长24 ～28 mm,平均26 mm).回顾性分析临床疗效和并发症防治,术前、术后采用JOA进行评分,根据术后随访X线及CT评价上颈椎结构的恢复情况.结果 所有患者均获随访,随访时间3～45个月,平均23个月,全组病例未发生与置钉相关的并发症,临床症状得到不同程度的改善,术前,术后6个月JOA评分改善率为73.1％ ～93.6％,平均81.2％.复查X线片、CT未见上颈椎失稳及复位丢失征象,螺钉位置良好,无松动、断钉,齿突均骨性愈合,椎间融合率为100％.术后随访效果满意.结论 经后路寰枢椎椎弓根钉棒系统内固定融合术治疗上颈椎不稳具有可行性,操作简便,固定牢固,疗效可靠.

Treatment of upper cervical spine instability with posterior fusion plus atlantoaxial pedicle screw

Objective To evaluate the clinical efficacies,indications and application values of posterior fusion plus pedicle screw fixation in the treatment of upper cervical spine instability.Methods From May 2006 to December 2010,a total of 24 patients with atlantoaxial instability were treated with C1-2 pedicle screws and rod fixation under general anesthesia.There were 18 males and 6 females with a mean age of 49.8 years old ( range:17 - 69 ).Results The postoperative radiographs verified a good position of all screws with satisfactory atlantoaxial reduction.A mean follow-up period of 23 months (range:3 -45 ) showed no injury of spinal cord and vertebral artery or interfixation failure.Atlantoaxial alignment and stability were restored without instrumentation-related complications.Conclusion Posterior atlantoaxial pedicle screw and rod fixation provide immediate three-dimensional rigid fixation of atlantoaxial joint.It is a more effective technique than with previously reported techniques.