Magerl术治疗未获完全复位的寰枢椎脱位  

C1-2 posterior transarticular screw fixation for incompletely-reduced atlantoaxial dislocation

作　　者：张宏其[1] 郭超峰[1] 陈静[1] 邓展生[1] 龙文荣[1] 肖勋刚[1] 胡建中[1] 王锡阳[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,长沙市410008

出　　处：《中国脊柱脊髓杂志》2006年第5期354-357,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨Magerl术治疗未获完全复位的寰枢椎脱位的可行性及手术技巧。方法:2003年12月至2005年3月,对12例术前无固定神经定位体征、术中未获完全复位的寰枢椎不稳患者行后路经寰枢椎侧块关节UCSS空心螺钉固定(Magerl术)、植骨融合术,对寰椎后弓完整的8例患者同期行后路寰枢椎钛缆固定术(Gallie术式)。通过随访并摄寰枢椎张口位和颈椎侧位X线平片,评估螺钉位置和植骨融合情况。结果:所有患者均完成双侧经关节螺钉固定,症状明显改善,无神经症状加重表现,无神经血管损伤等并发症发生。随访4～18个月(平均8个月),术后寰枢关节仍存在前脱位或(和)侧方脱位,但螺钉均通过寰枢椎侧块关节,所有置入螺钉位置准确,无寰枕关节活动受限。术后3～6个月均获骨性融合。结论:不能完全复位的寰枢关节脱位并不是Magerl术的绝对禁忌证,只要术前作好寰枢椎影像学检查并认真评估其可行性,术中采用“个体化”进钉方案,保证关节螺钉通道周围有充足的骨质,Magerl术仍是安全、可靠的。Objective：To discuss the feasibility and technical points of performing the C1-2 posterior transarticular UCSS screw fixation on patients with irreducable atlantoaxial dislocation.Method：Twelve patients with incompletely-reduced atlantoaxial dislocation were treated with bilateral C1-2 posterior transarticular screw fixation,of these,8 cases with C1 posterior arch intact underwent one-stage Magerl surgery combined with C1-2 posterior GaUie.These patients＇ clinical outcomes postoperative CT scan was performed to assess the instrumentation.Result：All patients underwent surgery successfully,without severe complications such as injury of nerve or blood vessels,neurological function improved remarkably.All patients were followed up for 4- 18 months（mean,Smonths）.C1-2 dislocation（anteriorly and laterally） was evidenced radiographily in some patients no screw perforation was documented.The atlanto-occipital joint was kept intact in all cases.All patients got C1-2 bony fusion within 3 to 6 months postoperatively.Conclusion：For patients with incompletely-reduced atlantoaxial dislocation,individualized instrumentation combined with excellent cancelous bone graft can ensure this kind of surgery feasible and safe.

关 键 词：寰枢关节脱位 内固定 关节融合 寰枢椎脱位 Magerl术 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]