不稳定性寰椎骨折有限内固定的研究  

C_1 lateral mass-C_2 pedicle screws and crosslink compression fixation for instable atlas fracture

作　　者：谭军[1] 倪春鸿[1] 李立钧[1] 周炜[1] 钱列[2] 

机构地区：[1]上海同济大学附属东方医院骨科,200120 [2]上海同济大学附属东方医院骨科,200120

出　　处：《中华医学杂志》2006年第25期1743-1747,共5页National Medical Journal of China

摘　　要：目的临床验证枢椎侧块枢椎椎弓根钉棒技术治疗不稳定寰椎骨折的可行性和可靠性及其价值。方法共收治寰椎骨折17例,其中不稳定性寰椎骨折为14例,对11例进行了有限内固定。11例中有6例合并轴向不稳及横韧带断裂;1例合并C2椎板骨折;余4例均为单纯轴向不稳。在解剖定位和透视辅助下进行枢椎侧块螺钉和C2椎弓根钉的置入后,两侧分别行钉棒联结固定;棒间横连接加压进行枢椎侧块的分离复位,恢复原有的枕骨、寰椎、枢椎间解剖吻合关系,合并轴向不稳及横韧带损伤者行C1-C2植骨融合术。结果平均手术时间124 min(90-176 min);平均失血量432 ml(270-1200ml);平均透视时间18 s;11例患者均未发生神经、椎动脉和其他手术相关并发症。全部患者均于术后5日颈托固定后下地行走;术后脊髓损伤症状无加重。1例因电刀灼伤C-C2间段椎动脉致椎动脉破裂,止血纱布、骨水泥填塞止血,未出现颅脑缺血症状。3个月颈椎侧位X线片显示均获得骨性愈合,无明显不稳征象。经术后CT证实骨折复位。结论针对具有不稳定性的寰椎骨折或合并寰横韧带损伤患者可在解剖定位和透视辅助下进行寰椎侧块枢椎椎弓根钉棒及横连接加压固定,达到枕骨、寰椎、枢椎间的解剖复位和维持,该短节段的生理性修复技术成功应用于严重寰椎骨折治疗有可能改变原有的治疗观念。Objectives To evaluate the feasibility and reliability of C1lateral-mass screw-C2 pedicle screw and crosslink compression fixation for Jefferson fracture. Methods Seventeen patients with atlas fracture, 12 males and 5 females, aged 42. 5 （25-67）, 4 of which with unstable atlas fracture, were treated. 11 cases underwent CI lateral mass and C2 pedicle screws and crosslink fixation, 6 of which had axial instability and rupture of atlas transverse ligament, 1 had C2 laminal fracture, and the other 4 had axial instability. With the assistant of regional anatomy study and fluoroscopy the CI lateral mass screw and C2 pedicle screw were inserted properly. Connecting rods were applied into the two screws on each side. Crosslink between the two rods were applied, compressing to achieve the realignment of the CI lateral mass fracture and Co-C1 -C2 into anatomical position. C1-C2 fusions with posterior bone graft were performed in the patients with axial instability or transverse ligament discontinuity. Results The operative time ranged from 90 to 176 min with an average of 124 min. The intra-operative blood loss ranged from 270 to 1200 ml with an average of 432 ml. Fluoroscopic examination was used for 18 seconds on average. There were no neurological deficits, vertebral artery related complications or other complications in all the patients. No neurological deficit was aggravated after the patient＇s mobilization with brace 5 days after operation. One case of vertebral artery rupture happened because of the use of electrocautery. The bleeding was stopped by the use of hemostatic sponge and bone cement without causing cerebral hemodynamic deficit. X-ray examination showed bone fusion and stability in all the patients three months after the operation. The restoration of the C2 fracture was confirmed by CT scan. Conclusion Osteosynthesis of the atlas by Cl lateral-mass screw-C2 pedicle screw and crosslink compression fixation is an ideal option for C1 burst fracture with or without rupture of transverse ligament. The pro

关 键 词：骨折固定术 内 寰椎 骨折 关节不稳定性 

分 类 号：R687.3[医药卫生—骨科学]