寰枢椎椎弓根钉棒固定融合治疗上颈椎不稳

目的:探讨寰枢椎椎弓根钉棒固定融合术治疗C1-2不稳的可行性.方法:2006年1月至2009年1月,在气管插管全麻下对18例C1-2不稳患者施行寰枢椎椎弓根钉棒固定融合术,取髂骨植骨,其中男11例,女7例;年龄17～62岁,平均37.7岁;病程3 d～30个月,平均10.6个月.患者术前均有不同程度的枕颈区疼痛和(或)四肢感觉、运动障碍,影像学均提示存在寰枢椎脱位和(或)不稳,JOA评分8～15分,平均11.4分;术后门诊随访,定期复查X线、CT和MRI,观察植骨融合情况,并记录JOA评分.结果:18例患者72枚螺钉成功置入,寰枢椎复位及固定满意,15例患者均获随访,时间6～24个月,平均11.5个月,术后脊髓压迫症状均有不同程度改善,末次随访JOA评分12～17分,平均14.5分;患者在3～6个月寰枢椎骨性融合,无螺钉松动,断钉及寰枢椎不稳现象.结论:对C1-2不稳的患者行寰枢椎椎弓根钉棒固定融合术,具有固定牢固、融合率高的优点,是一种切实可行的有效方法;但不推荐对存在寰椎椎动脉沟、后弓变异患者使用该技术.

The application of C1-2 pedicle screw fixation in treating atlantoaxial instability

Objective: To explore the feasibility of C1-2 pedicle screw fixation and fusion technique in treating atlantoaxial instability. Methods: From January 2006 to January 2009,18 patients with atlantoaxial instability were treated with C1-2 pedicle screws and plates fixation under general anesthesia. There were 11 males and 7 females,the age for 17-62 years with the mean of 37.7 years. The course of disease was from 3 days to 30 months with an average of 10.6 months. The patients had different degrees neck pain and disturbance of sensation or (and) dyskinesia,had atlantoaxial instability from images before operation. The JOA scoring before operation were from 8 to 15 with an average of 11.4. Bone fusion of patients was observed with X-rays,CT and MR image at the same time after operation and the JOA scoring was compared with preoperative. Results: A total of 72 screws were successfully placed in 18 cases,among them,15 cases were followed up from 6 to 24 months with an average of 11.5 months. Fifteen cases obtained bone fusion with time for 3-6 months without the complications of internal fixation failure or redislocation of atlas. The spinal compression had differently improved,postoperative JOA scoring was from 12 to 17 scores with an average of 14.5 scores. Conclusion: Pedicle screw fixation and fusion in atlas has advantages of firm fixation and high fusion rate,it is a better choics for atlantoaxial instability.It is not suitable for variations of sulcus of vertebral artery of atlas and posterior arch of atlas.