寰枢椎后路短节段个体化内固定治疗上颈椎损伤  

Individualized posterior atlantoaxial short-segmental fixation for upper cervical injury

作　　者：李菊根[1] 黄彦[1] 杨进顺[1] 黄文铎[1] 史群伟[1] 谢楚海[1] 

机构地区：[1]广州医学院第二附属医院骨外科,广州510260

出　　处：《中华创伤杂志》2013年第6期519-522,共4页Chinese Journal of Trauma

摘　　要：目的探讨寰枢椎椎弓根或侧块螺钉棒后路短节段内固定治疗上颈椎损伤的个体化置钉及其临床疗效。方法23例上颈椎损伤患者术前常规行颅骨牵引复位，个体化手术方案依据患者寰枢椎cT扫描及三维重建结果决定行椎弓根螺钉或侧块螺钉内固定以及螺钉的直径、长度和进钉点位置、方向、角度。结果术前Frankel分级C级6例、D级8例，术后均恢复至E级。随访6—36个月，所有患者内固定牢固，植骨均获得骨性愈合，其中3例年轻患者及1例寰椎左侧椎弓根螺钉偏外侧穿出骨皮质患者骨性愈合后取出内固定，临床效果均满意。结论个体化后路寰枢椎椎弓根螺钉或侧块螺钉钉棒固定系统是治疗上颈椎损伤的有效方法，具有三维固定牢固、固定节段短和术后并发症少等优点。Objective To observe the individualized insertion choice in treatment of upper cervical injury with posterior atlantoaxial short-segmental pedicle screws or lateral mass screws and the relevant clinical outcome. Methods A total of 23 cases of upper cervical injuries received skull traction preoperatively. Individual surgery plan including internal fixation using pedicle screws or lateral mass screws as well as diameter, length, entry point, direction, and angle of screws was determined according to their atlantoaxial CT scan and three-dimensional reconstruction results. Results Six cases of Frankel grade C and eight of grade D were all recovered to grade E after operation. All cases presented rigid fixation and bony fusion in the follow-up of 6 to 36 months. Besides, screws were removed after bony fusion for three young cases and one case with left atlas pedicle screws emerged laterally out of cortex. Clinical outcome was all satisfactory. Conclusion Individualized posterior atlantoaxial fixation using pedicle screws or lateral mass screws is an effective way to treat upper cervical injury and gains advantages of stable threedimensional structures, short fixation segments, and few nostoverative complications.

关 键 词：脊柱损伤 颈椎 枢椎 椎弓根钉 

分 类 号：R687.3[医药卫生—骨科学]