前路经寰枢关节螺钉内固定治疗寰枢椎不稳  

Anterior atlantoaxial transarticular screw fixation for treatment of atlantoaxiai instability

作　　者：刘曦明[1] 康辉[1] 徐峰[1] 蔡贤华[1] 陈庄洪[1] 

机构地区：[1]广州军区武汉总医院骨科,武汉430070

出　　处：《中华创伤杂志》2013年第4期307-310,共4页Chinese Journal of Trauma

摘　　要：目的评估前路经寰枢关节螺钉内固定治疗寰枢椎不稳的临床疗效。方法选择2004年3月一2009年6月收治的寰枢椎不稳患者32例，其中男21例，女11例；年龄22—64岁，平均49岁。寰枢椎不稳的原因：齿状突陈旧性骨折10例，游离齿状突畸形16例，横韧带损伤2例，类风湿关节炎4例。32例患者均在皮层体感诱发电位（corticalsomatosensory evoked potential，CSEP）监测下行前路经寰枢关节螺钉内固定术。记录手术时间、失血量及并发症情况，采用日本骨科协会（JOA）评分评估术前和术后1年神经功能情况。结果32例患者平均手术时间98min，平均出血量110ml，术中无食管、神经、椎动脉损伤或脑脊液漏。术后所有患者均获随访，时间12—31个月，平均19个月。JOA术前评分为9．8分，术后1年为15．8分，改善率为83％。所有患者均植骨融合，内固定位置良好。2例患者术后出现舌下神经损伤症状，术后2个月恢复。结论前路经寰枢关节螺钉固定是治疗寰枢椎不稳的有效方法之一。Objective To analyze clinical outcome of anterior atlantoaxial transarticular screw fixation in treatment of atlantoaxial instability. Methods Thirty-two patients with atlantoaxial instability treated between March 2004 and June 2009 were enrolled in the study. The patients consisted of 21 males and 11 females, at age of 22-64 years （mean 49 years ）. Atlantoaxial instability was attributed to old odontoid fracture in 10 patients, free odontoid malformation in 16, transverse ligament rupture in two, and rheumatoid arthritis in four. Anterior atlantoaxial transarticular screw fixation under monitoring of cortical somatosensory evoked potential （CSEP） was performed for all patients. Operation time, intraoperative blood loss, and complications were recorded. Japanese Orthopedic Association （JOA） scoring system was used to evaluate neurologic function preoperatively and at one year postoperatively. Results Operation lasted for average 98 minutes and intraoperative blood loss averaged 110 ml. Injuries on esophagus, nerve and vertebral arteries as well as leakage of cerebrospinal fluid were not observed in operation. All patients received a follow-up of 12-31 months. JOA score was increased from preoperative 9.8 points to 15.8 points at one year postoperatively, with improvement rate of 83%. Bone fusion and satisfactory internal fixation were achieved in all patients. Hypoglossal nerve injury symptom was found in two patients postoperatively and was recovered two months later. Conclusion Anterior aflantoaxial transarticular screw fixation is an effective treatment for atlantoaxial instability.

关 键 词：脊柱损伤 寰枢关节 骨折固定术 内 前路 

分 类 号：R687.3[医药卫生—骨科学]