椎弓根螺钉技术治疗游离齿状突并寰枢椎脱位的疗效观察  

Efficacy of pedicle screw technique in treatment of os odontoideum combined with atlantoaxial dislocation

作　　者：王玉强[1] 王利民[1] 张玮[1] 刘屹林[1] 王卫东[1] 谭洪宇[1] 陈豪[1] 

机构地区：[1]郑州大学第一附属医院骨科2病区,450052

出　　处：《中华创伤杂志》2012年第3期232-237,共6页Chinese Journal of Trauma

摘　　要：目的评估椎弓根螺钉技术治疗游离齿状突并寰枢椎脱位的疗效和影像学变化。方法对15例游离齿状突并寰枢椎脱位患者利用椎弓根螺钉技术行枕颈融合术或寰枢椎固定术，其中2例难复型脱位者先行经口入路寰枢关节松解术、1例行后弓切除加枕颈融合术；2例寰椎畸形及1例幼儿行枕颈融合术；其余患者均行寰枢椎椎弓根螺钉内固定术。随访患者临床表现和影像学改变，评估临床疗效。结果所有患者均获随访7—47个月，平均26个月。15例患者中，症状明显改善13例，好转2例。日本骨科学会（JOA）评分由术前平均8．27分增加到术后6个月的15分。根据Hirabayashi方法计算术后改善率，平均改善率为77％，其中优10例，良5例，优良率为100％。颈髓延髓角由术前平均130．3°增加到术后151．7°；术后x线片及cT提示寰枢椎序列良好，所有患者均获得骨性融合，无内固定脱落、断裂等并发症。结论利用椎弓根螺钉技术行枕颈融合术或寰枢椎固定术是治疗游离齿状突合并寰枢椎脱位的有效方法。Objective To evaluate the efficacy and radiological variation of pedicle screw technique in the treatment of os odontoideum combined with atlantoaxial dislocation. Methods Fifteen patients with os odontoideum combined with atlantoaxial dislocation were treated with occipitocervical fusion or atlantoaxial fixation. Two patients with irreducible atlantoaxial dislocation were treated surgically with transoral anterior atlantoaxial release and one treated with posterior arch removal plus oecipitocervical fu- sion. Two patients with atlas deformity and one infant were treated with occipitocervical fusion. The rest patients were treated with posterior reduction and pedicle screw internal fixation. Clinical manifestations and imaging changes were followed up to evaluate the clinical efficacy. Results All patients were fol- lowed-up for average 26 months （range, 7-47 months）. Neurological recovery was significantly improved in 13 patients and took a turn for the better in two. The average JOA scores was increased from average preoperative 8.27 to postoperative 15. According to Hirabayashi, the average improvement rate was 77%, including 10 patients with excellent outcomes and five with good outcomes, with excellence rate of 100%. The cervical-medullary angle was increased from average preoperative 130.3°to postoperative 151.7°. Postoperative X-rays and CT showed good atlantoaxial alignment and solid bony fusion in all patients, with no shedding or breakage of the fixators. Conclusion Occipitocervical fusion or atlantoaxial fixation through pedicle screw technique is an effective method for treatment of os odontoideum combined with irreducible atlantoaxial dislocation.

关 键 词：脊柱骨折 寰椎 枢椎 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]