寰枢椎不稳的手术治疗  

Surgical treatment of atlantoaxial instability

作　　者：乔广宇[1] 张远征[1] 余新光[1] 周定标[1] 潘隆盛[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《军医进修学院学报》2010年第4期303-304,306,共3页Academic Journal of Pla Postgraduate Medical School

基　　金：国家自然科学基金(30973032)~~

摘　　要：目的总结后路中线和侧方固定治疗寰枢椎不稳的效果。方法分别采用后路中线线缆和椎板夹技术以及寰椎侧块与枢椎椎弓根螺钉技术对68例先天性寰枢椎不稳患者进行植骨内固定。结果所有病例均获得术后即刻稳定,术中未发生脊髓和椎动脉损伤,无死亡、重残或其他手术并发症。47例获3月～7年随访,平均17个月。术后颈部疼痛均消失,肢体肌力有不同程度改善。过伸过屈位X光片检查显示内固定材料无松动、断裂,46例植骨块融合,1例术后1年复查发现植骨块吸收,做了翻修手术并随访1年,植骨块融合。结论后路中线线缆技术可以达到稳定寰枢椎、植骨融合的目的,适合大多数寰枢椎不稳患者;颈1-2侧块固定可以作为中线固定技术的补充手段。Objective To summarize the effect of midline and lateral fixation for atlantoaxial instability. Methods Bone grafting and internal fixation were performed for the atlantoaxial instability in 68 patients with interlaminar or interspinous cable and clamp or atlas and axis vertebrae screw through the midline or lateral mass. Results Immediate rigid segmental stabilization was observed in all cases with no procedure-related morbidity or mortality. Forty-seven patients were followed up for 3 months -7 years （averaged 17 months）. Pain of neck was disappeared and the myodynamia of extremities was improved at different extents after operation. No internal fixation breakage or loosening or dislocation was observed on dynamic radiographs 3 months after operation. Stable osseous fusion or well-aligned fibrous union was found in 46 patients. Follow-up 1 year after operation found that the grafted bone was absorbed and 1 patient experienced surgical operation showed that the grafted bone was absorbed in 1 patient and fused 1 year after repair. Conclusion Atlantoaxial stability and grafted bone fusion can be achieved in most atlantoaxial instability patients with midline sublaminar cable techniques. Lateral fixation of C1 and C2 can be used as an adjuvant method of midline fixation techniques.

关 键 词：神经外科手术 内固定器 寰椎 枢椎 

分 类 号：R651[医药卫生—外科学]