寰枢椎椎弓根螺钉技术治疗陈旧性齿状突骨折并寰枢椎失稳

目的：探讨后路寰枢椎椎弓根钉技术治疗陈旧性齿状突骨折并寰枢椎失稳的疗效。方法：2005年1月～2010年1月，本院对48例陈旧性齿状突骨折并寰枢椎失稳患者行后路寰枢椎椎弓根钉复位固定，其中男性30例，女性18例，年龄19～56岁，平均45．1岁。本组术前均行颅骨牵引。结果：本组48例患者共置入寰椎和枢椎椎弓根螺钉各96枚，寰枢椎复位满意，术中无脊髓损伤。术中出血250—900ml，平均370ml，手术时间110-280min，平均155min。术中3例出现椎动脉损伤，3例出现寰椎后弓下壁破裂。术后均获得随访，9～64个月，平均46．6个月。随访所有患者均在术后6个月获得骨性融合，未发现螺钉松动、移位，螺钉断裂，寰枢椎再移位、失稳现象。JOA评分由术前的7．1-2．8，改善至术后的13．3-2．1，P〈0．05。结论：寰枢椎椎弓根螺钉内固定技术具有良好的复位效果，为寰枢椎不稳患者治疗提供了一种较好的内固定术式。

Atlantoaxial Pedicle Screw Fixation for Old Odontoid Process Fracture with Atlantoaxial Destabilization

Objective：To explore the clinical effect of trans-atlantoaxial pediele screw-rod internal fixation and fusion for old odontoid process fracture with atlantoaxial destabilization. Methods： From January 2005 to January 2010, 48 cases of old odontoid process fracture with atlantoaxial destabilization （including 30 male and 18 female, with an average age of 45.1 years old） underwent trans-atlantoaxial pediele screw-rod interhal fixation and fusion in our hospital, and skull traction was given to all patients preoperatively. Results： Vertebral artery injury was noted in 3 cases and rupture of inferior wall of arcus posterior atlantis was noted in 3 cases intraoperatively, but no spinal cord injury was noted. Amount of blood loss was 250-900ml, time of operation was l lO-280min. Postoperative radiographs showed a good position of all screws and a satisfactory atlantoaxial reduction. All cases were followed up for an average duration of 46.6 months （range, 9- 64months） and got a bony fusion 6 months after operations. There was no looseness or breakage of screwrod noted. The JOA scores were improved from 7.1±2.8 （preoperation） to 13.3±2.1 （postoperation）. Conclusion： Atlantoaxial pediele screw fixation for treatment of atlantoaxial instability is reliable and effective.