寰枢椎椎弓根螺钉治疗寰枢椎不稳的临床疗效和手术策略

目的探讨运用寰枢椎椎弓根螺钉治疗创伤性寰枢椎不稳的临床效果和手术策略。方法 2007年～2010年中运用寰枢椎椎弓根螺钉治疗创伤性寰枢椎不稳15例,观察术后近期疗效、植骨融合及并发症。结果 14例患者均顺利完成手术,1例患者由于置钉困难改行寰枢椎后方植骨融合术。寰椎置钉28枚,未发现神经损伤。枢椎置钉28枚,未出现椎动脉损伤。术后渗血1例,颈部肿胀3例,无神经症状加重,无切口感染和脑脊液漏,随访3个月～3年,平均1.8年,所有病例均成功寰枢椎融合,颈椎序列和生理曲度良好,无明显丢失,未见内固定松动或断裂。随访时,脊髓功能Frankel分级评分3例D级均恢复到E级。结论寰枢椎椎弓根螺钉内固定技术治疗创伤性寰枢失稳的可操作性、力学稳定性及融合率均取得满意效果,虽然操作上技术要求较高,并有损伤C2神经根、寰枢椎间静脉丛及椎动脉的可能性,但仍不失为一种疗效可靠的方法,可以在有条件的基层医院开展。

Effect and Operation Strategy for treatment of traumatic atlantoaxial instability by C1,2 pedicle screw-rods internal fixation

Objective To evaluate the clinical effect and surgical strategy of C1,2 pedicle screw-rods intemal fixation for traumatic atlantoaxial instability.Methods 15 cases of traumatic atlantoaxial instability were treated by C1,2pedicle screwrods internal fixation and bone graft fusion in years of 2007-2010.The immediate outcome,fusion and complications were observed.Results 14 patients were successfully treated by C1,2 pedicle screw-rods intemal fixation.1 case was treated by post atlantoaxial fusion because pedicle screw fixation was difficult.28 screws were inserted into Atlas：Nerve damage was not found.28 screws were inserted into Axis：Vertebral artery injury did not occur.Postoperative bleeding in 1 case and neck swelling in 3 cases were observed.There was no neurological symptoms increase or wound infection and cerebrospinal fluid leakage.Follow-up for 3 months-3 years（the average is 1.8 years）,all patients got atlantoaxial fusion successfully,and were well in cervical sequence and physiological curvature.No interfixation failure was observed.Spinal cord function score of Frankel were restored from grade D level to the E level in 3 cases.Conclusion We have gotton satisfactory results by C1,2 pedicle screw-rods intemal fixation for traumatic atlantoaxial instability in operational,mechanical stability and rate of fusion.Although higher skills have been required,and injury of C2 nerve root,atlanto intervertebral venous plexus and vertebral artery is possible,it is still an effective and reliable method and can be launched in local hospitals.