寰椎椎弓根螺钉及枢椎椎板螺钉固定植骨融合治疗创伤性上颈椎不稳  

C2 laminar screws combined with C1 pedicle screws for surgical treatment of upper cervical instability

作　　者：马维虎[1] 刘观燚[1] 徐荣明[1] 孙韶华[1] 胡勇[1] 朱颜召[1] 

机构地区：[1]宁波市第六医院骨科,315040

出　　处：《中国脊柱脊髓杂志》2010年第3期214-218,共5页Chinese Journal of Spine and Spinal Cord

基　　金：浙江省医药卫生科学研究基金资助项目(2008B171)

摘　　要：目的:探讨寰椎椎弓根螺钉及枢椎椎板螺钉固定、植骨融合治疗创伤性上颈椎不稳的临床疗效。方法:2005年10月至2008年6月,采用后路寰椎椎弓根螺钉及枢椎椎板螺钉或椎弓根螺钉固定技术治疗创伤性上颈椎不稳患者43例,其中枢椎椎板螺钉固定组(A组)21例,枢椎椎弓根螺钉固定组(B组)22例。所有患者均有寰枢椎半脱位或不稳,表现为不同程度的颈枕区疼痛,活动受限。均使用颈椎后路Vertex钉棒系统固定。对比两组的手术时间、术中出血量,有无神经、血管、脊髓损伤和内固定松动、断裂失败并发症,是否出现复位丢失和植骨融合率。结果:A组手术时间1～3h,平均1.5h,出血量100～650ml,平均240ml。B组手术时间1.2～3h,平均2h,出血量120～800ml,平均350ml。A组手术时间和术中出血量明显少于B组(P<0.05)。A组有2例、B组有3例术中在剥离时损伤C1-2间静脉丛,均用明胶海绵压迫止血成功。术后CT显示B组1例单侧枢椎椎弓根螺钉部分进入横突孔,但无症状,余枢椎椎弓根螺钉和椎板螺钉均位置良好,未见椎动脉、神经损伤及脑脊液漏并发症。43例术后获12个月～3年随访,平均20.3个月,所有患者均于术后3～4个月获得骨性融合,术后X线片显示颈椎稳定,未见复位丢失,亦未见内固定松动退出或断裂。结论:对创伤性上颈椎不稳患者应用寰椎椎弓根螺钉及枢椎椎板螺钉固定不仅具有椎弓根螺钉同等的固定疗效,而且相对安全、简单,可以作为椎弓根螺钉固定的一种补充方法。Objective：To explore the clinical outcomes and complications of C2 laminar screws combined with C1 pedicle screws for surgical treatment of upper cervical instability.Method：From October 2005 to June 2008,43 cases with atlantoaxial instability undergoing C2 laminar screw and pedicle screw combined with C1 pedicle screws instrumentation were reviewed retrospectively.There were 21 cases for C2 laminar screw fixation（group A） and 22 cases for C2 pedicle screw fixation（group B）.All cases presenting with atlantoaxial instability such as craniocervical junction pain underwent instrument of vertex cervical internal fixation system,the surgery time,blood loss,complications,the status of instrument failure,reduction loss,and bone union rate between two groups were reviewed comparatively.Result：The surgery time for group A arranged 1-3h,with an average of 1.5h,the blood loss arranged 100-650ml,with an average of 240ml,while the surgery time for group B arranged 1.2-3h,with an average of 2h,the blood loss arranged 120-800ml,with an average of 350ml（P0.05）.Two cases in group A and three cases in group B were complicated with veiniplex injury with no heavy blood loss due to successful hemostasia.There was one screw in group B placed medially so as to penetrating into the spinal canal without any complication.All laminar screws were placed satisfactorily.No spinal cord and vertebral artery injury during surgery was noted.All patients were followed up for twelve months to three years.No instability as well as evidence of instrument failure during follow-up period was documented in all patients.The bony union was evidenced in all cases at 3 to 4 months with no reduction loss.Conclusion：Posterior C2 laminar screw combined with C1 pedicle screws instrumentation can provide equal strong stability and high fusion rate to posterior pedicle screw fixation,the surgical maneuver is simple and safe which may be a reliable alternative to pedicle screw fixation.

关 键 词：枢椎椎板螺钉 椎弓根螺钉 内固定 上颈椎不稳 

分 类 号：R687.3[医药卫生—骨科学] R683.2[医药卫生—外科学]