寰枢椎椎弓根螺钉系统在上颈椎不稳的应用  

Application of C1,C2 pedicle screw fixation in atlantoaxial instability

作　　者：贺瑞[1] 尚希福[1] 许翔[1] 胡飞[1] 张文志[1] 胡业丰[1] 姚刚[1] 程鹏[1] 

机构地区：[1]安徽医科大学附属省立医院骨二科

出　　处：《骨科》2011年第3期126-128,共3页ORTHOPAEDICS

摘　　要：目的探讨寰枢椎椎弓根螺钉固定系统用于上颈椎不稳的效果。方法 2005年2月~2009年5月,23例上颈椎不稳患者,年龄17~64岁,平均43.6岁,男15例,女8例。新鲜骨折12例,陈旧性骨折7例,寰椎横韧带断裂4例;齿状突骨折按Anderson-D’Alonzo分型,Ⅱ型11例,Ⅲ型8例;7例合并神经系统症状。所有患者术前给予颅骨牵引,根据术前三维CT成像的指导确定寰枢椎进针角度以及长度。一般为椎弓根螺钉3.5mm,寰椎14~16mm,枢椎24~28mm。对术前三维CT提示寰椎有异常的病例在开口点打开皮质后给予刮齿行进钉通道松质骨刮出,直接显露出约8~10mm通道,避开椎管后顺势植入螺钉。结果所有患者手术顺利,手术时间110~170min,术中出血量210~600ml,平均350ml。术前7例合并神经系统症状者术后均完全恢复。1例术后摄片提示为寰椎椎弓根钉偏离,耳周疼痛,6月后三维CT复查,植骨融合,拔除内固定。术后复查全部患者植骨融合,内固定无松动,头部活动受限均不明显。结论寰枢椎椎弓根内固定系统治疗齿状突骨折具有固定阶段短,三维固定,融合率高,对头颈部活动影响小等优点。Objective To investigate the effect of C1,C2 pedicle screw fixation and fusion technique in atlantoaxial instability.Methods From Feb.2005 to May 2009,23 cases of atlantoaxial instability undergoing the trans-pedicle fixation were reviewed.There were 15 males and 8 females,with a mean age of 43.6 years（range 17 to 64 years）.There were 7 cases of old odontoid fracture,12 cases of fresh odontoid fracture,4 cases of fragmentation of ligament transversum atlantis.All cases were subjected to skull traction preoperation.The implantation positions of C1,C2 were directed by three dimensional CT preoperation.The diameter of screw was 3.5 mm,and the length of screw of C1 and C2 was 14-16 and 24-28 mm respectively.Preoperatively,when abnormal structure of C1 existed in three dimensional CT,the passage in pedicle of vertebral arch was shaved with the little barb,and 8-10 mm was safe length enough for planting pedicle screw.Results The operation time was 110-170 min,and intraoperative blood loss was 350 ml（range 210 to 600 ml）.One screw was inserted so medially as to penetrating into the spinal canal,unwell around the ear.The clinical and radiologic follow-up data indicated union of fracture;bone of graft was alive and there was no loosening of internal fixation.Conclusion C1,C2 pedicle screw fixation and fusion technique for atlantoaxial instability has following advantages： less segment,three dimensional fixation,high fusion rate and less influence of function.

关 键 词：寰椎 枢椎 椎管 颈椎 骨螺丝 

分 类 号：R687.3[医药卫生—骨科学]