寰枢椎椎弓根钉内固定重建上颈椎不稳  

Atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability

作　　者：杨飞[1] 武永刚[2] 赵敏 贾卫斗[1] 云得才[1] 王建华[1] 

机构地区：[1]解放军第二五一医院骨一科,河北张家口075000 [2]内蒙古自治区巴彦淖尔市医院骨科,015000 [3]河北省张家口市第五医院外科

出　　处：《中国医师进修杂志》2010年第29期34-37,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨寰枢椎椎弓根钉内固定融合重建上颈椎不稳的临床疗效。方法采用寰枢椎椎弓根钉内固定自体髂骨植骨治疗上颈椎不稳患者21例，其中Ⅱ型齿状突骨折13例，齿状突不连5例，横韧带损伤3例。在寰枢椎后弓问植骨融合，使寰枢椎复合体得到稳定。结果共置入84枚螺钉，术中2枚螺钉穿破寰椎左侧椎弓根外侧壁，未发生脊髓、椎动脉损伤。所有患者x线片示寰椎完全复位，枢椎齿状突骨折处复位良好。CT片示螺钉与椎动脉及脊髓位置关系良好。按JOA评分标准，优15例，良3例，可2例，差1例，优良率85．71％（18／21）。17例患者获得随访，随访时间12。26（12．83±4．23）个月，均获得骨性融合，未发现钉板断裂。结论寰枢椎椎弓根螺钉结合钉板系统固定重建上颈椎不稳能显著增强寰枢椎间生物力学稳定性，植骨融合率高，该术式在寰枢椎融合术中具有较高的推广应用价值。Objective To explore the clinical effect of the atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability. Methods Using atlanto-axial pedicle screw and internal fixation system combined with autogenous iliac bone graft to treat 21 patients with upper cervical spine instability. Type Ⅱ odontoid process old fracture was 13 patients, odontoid process nonunion was 5 patients, injury of the transverse ligament was 3 patients. They were placed in 84 atlanto-axial pedicte screws, autogenous bones were placed in the posterior arch of adas and axis to fusion, so that atlanto-axial complex got stabilized. Results The left lateral cortical bone of atlas vertebral pedicle was broken by screws in 2 patients, but the spinal cord and vertebral artery was intact. X-ray film showed the atlas and the fracture of dens of axis was completely replaced in all patients. The position of screw and vertebral artery or spinal cord was good in CT image. According to JOA score standard, 15 cases of all were excellent, 3 cases were good,2 cases were common,1 case was bad, and the rate of excellent and good was 85.71% （18/21）. Seventeen cases were followed up for 12-26 （12.83 ± 4.23） months, all patients had acquired bone fusion and found no screw and plate fracture. Conclusions Aflanto-axial pedicle screw combined with screw-plate system fixation to treat upper cervical spine instability, can significantly enhance the biomechanical stability of the atlanto-axial interbody, bone grafting fusion rate is higher, the application value of the atlanto-axial fusion is higher.

关 键 词：寰椎 枢椎 椎弓根 钉板系统 

分 类 号：R687.3[医药卫生—骨科学]