寰枢椎失稳并脊髓不全损伤的外科治疗  

Surgical Management for Atlantoaxial Instability with Incomplete Spinal Cord Injury

作　　者：郝定均[1] 吴起宁[1] 贺宝荣[1] 雷伟[2] 孙宏慧[3] 宋宗让[1] 

机构地区：[1]西安市红十字会医院脊柱科,710054 [2]第四军医大学骨科研究所,710032 [3]第四军医大学唐都医院骨科,710038

出　　处：《美中国际创伤杂志》2008年第1期10-13,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的：讨论上颈椎失稳并脊髓不全损伤的诊断和治疗方法。方法：男116例，女76例，平均年龄41岁。齿突骨折47例（新鲜骨折38例，陈旧性骨折9例），Hangman骨折45例（新鲜骨折28例，陈旧性骨折17例），寰椎横韧带断裂24例，先天畸形23例，寰椎单侧椎弓骨折19例，类风湿性关节炎17例，一侧关节突骨折9例，Jefferson骨折并慢性不稳3例，肿瘤4例。齿突螺钉固定29例，颈2-3椎间融合10例，寰枢椎Apofix固定融合27例，颈枕融合Axis固定29例，Cervifix固定36例，Simmons寰枢固定融合32例，Brooks固定融合8例，钢丝加关节突螺钉固定8例。经椎弓根加压螺钉固定，植骨融合4例，其他方法1例。结果：平均随访4年9个月。189例获得骨性愈合，延迟愈合3例，钢丝断裂2例，椎体移位1例。椎动脉损伤6例，神经根损伤12例，退钉10枚。JOA改善率79．9％，无脊髓损伤加重者。结论：恰当的手术方法是治疗的基础，内固定物的选择可减少并发症。Objective： To discuss the diagnosis and surgical treatment of upper cervical spine instability with incomplete spinal cord injury. Methods： 192 cases （including 116 male and 76 female, with an average age of 41） of upper cervical spine instability with incomplete spinal cord injury were treated in this group. There were 47 cases of odontoid process fracture （38 cases with fresh fractures, 9 cases with timeworn fractures）,45 cases of Hangman fracture （28 cases with fresh fractures, 17 cases with timeworn fractures）, 24 cases of torn transverse ligament of atlas, 23 cases of congenital deformity, 19 cases of unilateral fracture of vertebral arch of atlas, 17 cases of rheumatoid arthritis, 9 cases of unilateral fracture of articular process, 3 cases of Jefferson fracture with chronic instability, 4 cases of spinal tumor. There were 29 cases were treated by odontoid screw fixation, 10 cases by intervertebral fusion of C2-C3, 27 cases by atlantoaxial fusion followed by Apofix fixation, 65 cases by occipitocervical fusion followed by internal fixation（29 cases with Axis, and 36 cases with Cervifix ）, 32 cases by Atlantoaxial fusion and Simmons fixation, 8 cases by Brooks fixation：8 cases by articular process screw fixation together with spinal wire, 4 cases by compressed pedicle screw fixation and bone graft, 1 case by other method. Results： With an average follow-up period of 4 years and 9 months, 189 cases obtained bony union, 3 cases obtained delayed union, broken wire occurred in 2 cases, transposition of vertebral body noted in 1 case, vertebral arterial injury noted in 6 cases, nerve root injury noted in 12 cases, and 10 screws moved back. Improvement rate of JOA was 79.9%, There was no deteriorations in spinal cord injury. Conclusion： A proper surgical method is the essential treatment and a suitable fixator can decrease post-operative complications.

关 键 词：寰枢关节 关节不稳 关节固定术 

分 类 号：R683.2[医药卫生—骨科学]