用微创理念行后路椎弓根钉板内固定植骨融合术治疗寰枢椎不稳  

Posterior Fixation of Lateral Pedicle Screws and Plates for Atlantoaxial Instability Using Micro-injury Methods

作　　者：孙继飞[1] 刘振利[1] 刘晓伟[1] 陈庆胜[1] 高岩[1] 

机构地区：[1]中国人民解放军第251医院骨二科,张家口075000

出　　处：《中国现代手术学杂志》2011年第4期273-275,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨用微创理念行后路椎弓根钉板内固定植骨融合术治疗寰枢椎不稳的方法及临床效果。方法采用后路椎弓根螺钉技术对23例寰枢椎不稳定的患者进行内固定。手术前均行颅骨牵引复位,术前先在X线片及CT上测定好进钉点以及角度、方向,选择螺钉、连接板的长度。寰椎进钉点选择在寰椎后结节中点旁开18～20 mm与后弓下缘以上2 mm的交点,螺钉内斜角度为0°,上斜角度为5°。枢椎进钉点为枢椎下关节突根部中点,螺钉角度上斜30°,内斜约10°,螺钉直径3.5 mm,寰椎螺钉长28～32 mm,枢椎螺钉长22～26 mm。结果均达到解剖复位、术中未损伤脊髓和椎动脉,术中出血量82(68～96)ml,2例齿状突骨折出现过度复位,术中经重新调整后解剖复位。本组平均随访15(10～25)个月,所有患者均症状消失,植骨融合,无内固定松动、断裂。结论用微创的理念行后路椎弓根钉板内固定植骨融合术治疗寰枢椎不稳可提高手术的精确度并将手术创伤降到最低。Objective To explore the best posterior fixation method of atlantoaxial instability by microinjury method. Methods A total of 23 cases were fixed by using with lateral pedicle screws and plates. Skull traction was performed before operation. According to the imaging of X-ray films and CT, the best entrance point, angle and direction were determined, and the types of the screws and the plates were chosen. The entry point of atlas pedicle screws was placed at 18 - 20 mm beside the midpoint of atlas tubercle and at the point of intersection 2mm inferior the boarder of posterior arch. The atlas pedicle screws were 0°inward and 5° upward. The entry point of axoidean screws was at the midpoint of the root of inferior articular process of axis with 30°upward and 10°inward. The screws was 3.5 mm of diameter, 28 - 32 mm long of atlas and 22 - 26 mm long of axis. Redult The follow-up for average 15 months showed that all cases obtained bony union without internal fixation breakage or loosening. Conclusion It can improve the surgical accuracy and reduce surgical trauma by using the concept of minimally invasive posterior pedicle screw-plate fixation and fusion in the treatment of atlantoaxial instability.

关 键 词：寰枢关节 关节稳定性 椎弓根螺钉 内固定器 植骨 

分 类 号：R687.3[医药卫生—骨科学]