Apofix椎板夹内固定在寰枢椎不稳治疗中的应用  

The use of Apofix interlaminar clamp for the treatment of atlantoaxial instability

作　　者：马乐群[1] 镇万新[1] 徐亮[1] 高国勇[1] 

机构地区：[1]暨南大学第二临床医院脊柱外科,深圳518020

出　　处：《中华骨科杂志》2005年第10期599-602,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨Apofix椎板夹内固定在寰枢椎不稳治疗中的应用价值。方法2000年4月至2004年7月,在颈后路切开复位手术中采用Apofix椎板夹内固定植骨融合治疗寰枢椎不稳30例。男24例,女6例;年龄19～67岁,平均41岁。寰枢椎脱位5例,齿突骨折25例。齿突骨折中有新鲜骨折21例,陈旧骨折、骨不连4例;AndersonⅡ型骨折23例,Ⅲ型骨折2例。颅骨牵引复位后,于术中显露寰枕间隙、寰椎后弓及枢椎椎板,置入Apofix椎板夹的上、下椎板钩。将取自髂骨的植骨块植入C1,2椎板间隙,夹紧连接杆完成固定。结果全部病例随访8～46个月,平均27个月。颈椎完全复位28例,不完全复位2例。术中平均出血65ml,手术时间70￣150min。术后颈围保护下坐起时间平均为术后第3天(第2～6天),无脊髓损伤或损伤较轻者离床活动时间平均为术后第7天(第2～10天)。术后3个月植骨融合。术前合并神经系统症状者16例,术后5例上颈椎神经根压迫症状消失或基本消失;11例脊髓损伤者术后脊髓功能均有不同程度改善,Frankel分级提高2级1例、1级8例、2例无变化。未发生椎动脉、神经根、脊髓损伤或脊髓损伤加重等严重并发症。结论Apofix椎板夹内固定具有操作简便、安全可靠等特点,为颈后路内固定提供了一种安全、有效的方法。Objective To discwss tile application of Apofix interlaminar clamp for the treatment of atlantoaxial instability. Methods Fronl April 2000 to July 2004, 30 patients with atlantoaxial instability were treated with posterior atlantoaxial fusion and Apofix fixation. There were 24 males and 6 females. The mean age of the patients was 41 years （range, 19 to 67 years）. The patients included 5 with atlantoaxial dislocation, 25 with odontoid fracture （including fresh fracture for 21, old fracture and nonunion for 4; Anderson Ⅱ for 23 and Anderson Ⅲ for 2）. After redueted by skull traction, atlanto-oecipital space, arcus posterior atlantis and axial laminar were exposed during operation, upper and lower hooks were inserted. The iliac bone graft was inserted into the space of Ci and C2, the connecting rod of the clamp was compressed and fixed. Results The follow-up of all cases ranged from 8 months to 3 years and 10 months （with the mean of 27 months）. There were 28 eases with complete reduction of fracture and dislocation, 2 cases in incomplete reduction. The operation time was 70 to 150 minutes, and the average blood loss was 65 ml. Patients could sit up 3 days （2 to 6 days） after surgery with soft collar. The mean off-bed time was 7 days （2 to 10 days） after operation in the patients without or less spinal cord injury. All cases obtained solid bony fusion 3 months postoperatively. No severe complications such as injuries of vertebral artery, nerve root and spinal cord or aggravation of spinal cord injury occurred. Conclusion Apofix interlaminar clamp has advantages of convenience in operation, provided reliable and safe stability for atlatoaxial segment. The results suggested that this technique is an efficient, reliable segmental posterior fixation.

关 键 词：寰枢关节 关节不稳定性 内固定器 Apofix椎板夹 后路内固定 寰枢椎不稳 融合治疗 无脊髓损伤 ANDERSON FRANKEL 切开复位 神经系统症状 

分 类 号：R687.3[医药卫生—骨科学]