陈旧性创伤性寰枢椎脱位的后路Apofix内固定治疗  

Posterior Treatment of Delayed Traumatic Atlantoaxial Joint Dislocation with Apofix Internal Fixation

作　　者：秦卫[1] 姜为民[2] 史金辉[2] 李雪峰[2] 杨惠林[2] 唐天驷[2] 

机构地区：[1]苏州市立医院北区骨科,江苏苏州215008 [2]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《苏州大学学报（医学版）》2010年第3期563-566,共4页Suzhou University Journal of Medical Science

摘　　要：目的观察Apofix椎板夹内固定器在陈旧性创伤性寰枢椎脱位后路融合术中的效果。方法对18例陈旧性创伤性寰枢椎脱位患者施行了后路Apofix内固定植骨融合术。先行颅骨牵引复位1～2周,于局麻下后正中入路显露寰枕间隙﹑寰椎与枢椎后方结构,于寰椎后弓与枢椎椎板间分别置入Apofix椎板夹,取髂骨块植于颈1、2椎板间。逐渐加压至恰当位置,然后锁紧。结果 18例患者随访(13～84个月),平均38个月。15例获得完全复位,3例部分复位,17例于术后3～4个月获得骨性融合;1例部分复位患者于术后3个月植骨块及内固定松动,寰枢椎脱位加重,再次行枕颈融合术。术前有16例伴有神经损伤表现,术后6例完全消失,10例明显改善。JOA评分由术前平均9.5分提高至术后平均15.8分。结论陈旧性创伤性寰枢椎脱位行后路Apofix内固定植骨融合术操作便捷,安全可靠,只要术前能获得满意的复位,术后处理得当,则疗效确切。Objective To assess the effect of posterior fixation and fusion with Apofix device for the treatment of delayed traumatic atlantoaxial joint dislocation.Methods Eighteen patients with delayed traumatic atlantoaxial joint dislocation were included.Posterior fixation and fusion with Apofix device were performed.First step was one or two week skull traction.After the atlantoaxial joint dislocation had been reduced,the posterior fixation and fusion with Apofix was performed.Using local anaesthesia,atlantoaxial interval and posterior structure of atlas and dentata were exposed by midline operative approach.Apofix interlaminar clamps were placed at posterior arch of atlas and odontoid vertebral laminae,autologous iliac bone graft was placed for fusion.Then the device to proper position was pressurized and items locked.Results All of the patients were followed up,the mean follow-up period was 38 months（13 ～84 months）.Fifteen patients obtained complete reduction,the others were partial reduction.Seventeen patients had successful fusion after 3 or 4 months,only 1 patient who had partial reduction had internal fixation loose and nonfusion,leading to recurrence of atlantoaxial joint dislocation.An occipitocervical fusion surgery was performed on this patient.As to neurological assessment,16 patients had neurological deficit before operation,while 6 of them recovered completely after operation,another 10 patients＇neurological status improved significantly.JOA score was improved from 9.5 pre-operative to 15.8 post-operative.Conclusion Apofix internal fixation and fusion seems to be feasible in treatment of delayed traumatic atlantoaxial joint dislocation.Successful reduction before operation and proper treatment after operation is also important.

关 键 词：寰枢椎 陈旧性 脱位 APOFIX 内固定 

分 类 号：R681.53[医药卫生—骨科学]