采用C1-2钉棒复位技术治疗难复性寰枢椎脱位及颅底陷入  

Treatment of fixed atlantoaxial dislocation and basilar invagination with C1-2 screw and rod reduction and fixation technique

作　　者：尹一恒[1] 余新光[1] 乔广宇[1] 佟怀宇[1] 周定标[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华医学杂志》2014年第41期3248-3251,共4页National Medical Journal of China

基　　金：国家自然科学基金青年项目（81301274）;中国博士后基金（2014M552653）

摘　　要：目的 介绍一种采用C1-2钉棒系统对难复性寰枢椎脱位和颅底陷入复位的技术.方法 回顾性分析2009年1月至2011年12月,在解放军总医院神经外科采用C1侧块C2椎弓根/峡部螺钉钛棒技术成功实现复位的26例难复性寰枢椎脱位及颅底陷入患者,其中男9例,女17例.最常见的临床症状是肢体力弱、颈部活动受限以及感觉异常.结果 26例均获得有效复位,其中18例完全复位,8例部分复位（复位程度＞60％）;术后寰齿间距均值为2.1 mm,较术前8.8 mm明显缩小（P＜0.01）.所有患者硬膜及延颈髓压迫解除,临床症状均有不同程度改善.术后2例出现并发症,包括肺部感染1例、切口延期愈合1例,经对症处理后均恢复.术后随访（平均22个月）植骨融合率达到100％.结论 C1-C2螺钉钛棒系统可以实现对难复性寰枢椎脱位及颅底陷入的有效复位及固定融合.对非寰枕融合患者该技术可保留寰枕关节,而对于寰枕融合患者该技术固定效果优于枕颈固定法.Objective To introduce a novel technique of reducing fixed atlantoaxial dislocation （FAAD） and basilar invagination （BI） with C1-C2 screw and rod system.Methods From January 2009 to December 2011,26 patients of FAAD and BI were reduced successfully with an insertion of C1 lateral mass and C2 pedicle/pars screw and rod system.The cohort had 17 females and 9 males.And their most common presenting symptoms were extremity muscle weakness,restricted neck movement and paresthesia.Results All of them achieved effective reduction.Among them,18 attained complete reduction and 8 partial reduction （over 60% extent of reduction）.The mean atlanto-dental interval （ADI） value was 2.1 mm postoperatively versus 8.8 mm preoperatively（t =21.1,P 〈 0.01）.All of them had relieved compression of dura and medulla oblongata and cervical cord.All clinical symptoms improved.One case had pulmonary infection while another case delayed healing of incision.Both recovered well after symptomatic treatments.Bony fusion reached 100% during a mean follow-up period of 22 months.Conclusion The C1-C2 screw and rod system may achieve effective reduction and fixation for FAAD and BI.Capable of preserving atlanto-occipital joints in patients without atlas assimilation,this procedure provide more solid immobilization than occipitocervical fusion in those with atlas assimilation.

关 键 词：难复性寰枢椎脱位 颅底陷入 颅颈交界区 侧块螺钉 复位术 

分 类 号：R687.3[医药卫生—骨科学]