后路融合术治疗齿状突游离小骨并寰枢椎不稳  

Posterior fusion for the treatment of os odontoideum with atlantoaxial instability

作　　者：周风金[1] 倪斌[1] 郭翔[1] 谢宁[1] 卢旭华[1] 李松凯[1] 张锋[1] 杨军[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中国骨科临床与基础研究杂志》2011年第2期120-125,共6页Chinese Orthopaedic Journal of Clinical and Basic Research

摘　　要：目的通过临床病例回顾,分析后路融合内固定术治疗齿状突游离小骨合并寰枢椎不稳的临床特点及疗效,为临床诊疗提供参考。方法 2006年10月至2008年12月,采用后路寰枢椎融合或枕颈融合术治疗合并寰枢椎不稳的齿状突游离小骨57例,男34例,女23例。年龄13～71岁,平均37.4岁。有明确外伤病史者41例。55例存在不同程度的脊髓压迫症状。术前ASIA(American Spinal Injury Association)脊髓神经功能分级:B级3例,C级33例,D级19例,E级2例。结果随访时间6～60个月,平均26个月。51例获得骨性融合,6例发生延迟愈合。无因手术操作致椎动脉和脊髓损伤病例。无内固定脱落、断裂、退钉等并发症。所有病例枕颈部症状消失,术后ASIA脊髓神经功能分级:C级5例,D级35例,E级17例。结论术前认真分析,选择合适的后路融合术式能有效治疗齿状突游离小骨合并寰枢椎不稳,减少手术并发症。Objective To analyze the clinical characteristics of os odontoideum with atlantoaxial instability and determine the efficiency of treatment by posterior atlantoaxial or occipitocervical fusion, and to try to provide reference to the diagnosis and management for os odontoideum with atlantoaxial instability. Method From October 2006 to December 2008, 57 patients with atlantoaxial instability caused by os odontoideum were performed by posterior atlantoaxial or occipitocervical fusion with different fixations. Among them 34 patients were men and 23 women, the mean age was 37.4 years old （range, 13 to 71 years old）, 41 patients had a definite history of neck injury and 55 cases had myelopathy. The preoperative neurological function of each patient was evaluated by the American Spinal Injury Association （ASIA） score system, there were B degree in 3 cases, C degree in 33, D degree in 19 and E degree in 2. Results All patients were followed up for 6 to 60 months （average, 26 months）. Fifty-one patients gained solid bony fusion and 6 had delayed fusion. No vertebral artery or spinal cord injuries caused by operative procedure occurred. There was no fixator disengagement, breakage or withdraw during the follow-up period. All patients had a relief of local symptoms, and neurological symptoms were substantially improved with C degree in 5 cases, D degree in 35 and E degree in 17. Conclusion Careful preoperative examination with suitable posterior fusion method choice can obtain effective results and less complications for os odontoideum with atlantoaxial instability.

关 键 词：寰枢关节 齿突尖 关节不稳定性 脊柱融合 

分 类 号：R687.3[医药卫生—骨科学]