后路寰枢椎椎弓根螺钉结合单侧枢椎棘突椎板钉固定治疗寰枢椎不稳的临床疗效  

The clinical effects of atlantoaxial pedicle screw combined with unilateral axial spinous process and lamina screws for atlantoaxial instability

作　　者：高志朝[1] 王梅[2] 王大勇[1] 陈四木[1] 徐荣明[3] 

机构地区：[1]杭州师范大学医学院附属余杭医院骨科,311100 [2]杭州师范大学医学院附属余杭医院ICU,311100 [3]宁波市第六医院骨科

出　　处：《中华骨科杂志》2015年第5期503-510,共8页Chinese Journal of Orthopaedics

基　　金：浙江省医药卫生科学研究基金（2011KYB093）

摘　　要：目的 探讨后路寰枢椎椎弓根螺钉结合单侧枢椎棘突椎板钉加同种异体骨植骨融合术治疗寰枢椎不稳的临床疗效.方法 回顾性分析2010年3月至2014年4月,采用枢椎棘突椎板钉结合寰枢椎椎弓根固定植骨融合术治疗10例寰枢椎不稳定患者资料,男6例,女4例;年龄16～ 62岁,平均39岁;单侧椎动脉高跨畸形伴寰枢椎不稳定7例,枢椎单侧关节突破坏累及椎弓根致寰枢椎不稳定3例.患者均表现为颈部活动受限及疼痛,VAS评分1～8分,平均（3.70±2.11）分,其中3例伴肌力下降及感觉异常.术前常规行影像学检查,术后7d及1、3、6、12个月行X线和CT检查,了解内固定位置及植骨融合情况;比较手术前后VAS评分.结果 10例患者均获得随访,随访时间9～18个月,平均13个月.术中无一例发生颈脊髓和椎动脉损伤,除1例颈部肌肉肥厚者需另开软组织通道置入螺钉外,其余均一次性置钉成功.1例术后第3天切口出现渗液,考虑为同种异体骨排异反应,对症换药后5天停止渗液,余切口均一期愈合.术后VAS评分（1.01±0.89）分,较术前明显减轻.术后X线片示颈椎序列恢复良好,CT示1例患者寰椎椎弓根钉道内侧皮质破损,椎管未侵犯,余螺钉位置正常;术后6个月X线片及CT检查均见骨性融合.结论 寰枢椎椎弓根螺钉结合单侧枢椎棘突椎板钉植骨融合术治疗寰枢椎不稳,近期疗效肯定.Objective To investigate the clinical effects of the posterior atlantoaxial pedicle screw fixation combined with unilateral axial spinous process and lamina screws and allogeneic bone graft for atlantoaxial instability.Methods From March 2010 to April 2014,data of 10 patients with atlantoaxial instability who had undergone atlanto-axial vertebral pedicle fixation and interbody fusion combined with posterior atlanto-axial spines lamina nails were retrospectively analyzed.There were 6 males and 4 females with an average age of 39 （range,16-62） years old.The inclusion criteria was atlantoaxial instability together with unilateral vertebral artery segment high cross deformity （7 patients） or atlantoaxial joint break bad involving unilateral pedicle （7 patients）.3 patients have spinal cord disease symptoms and physical signs,both suffered limited neck mobility and pain.The VAS scores were 1-8,with an average of 3.70±2.11.Preoperative X-ray,CT three-dimensional reconstruction and MRI were collected.X-ray and CT examination were performed 7 d and 1,3,6,12 months after operation to evaluate the internal fixation and bone grafting fusion.Results There＆#39;s no occurrence of cervical spinal cord and vertebral artery injury.Screws were successfully implanted.1 case＆#39;s incision occurred infiltration liquid 3 days after operation.For allograft rejection consideration,we changed the plan,and the infiltrating stopped 5 days later.Other incisions were all primary healing.VAS scores were 1.01±0.89 after operation,which was significantly reduced.X-ray showed good recovery of cervical sequence after the operation,and CT revealed 1 patient with atlas pedicle screw in the medial cortex damage.Spinal canal was without infringing,and the other screw positions were normal.6 months after operation,X-ray or CT examination both showed bony fusion.Conclusion Atlantoaxial pedicle screw fixation combined with unilateral axial spinous process and lamina screws and allograft bone graft fusion for the treatment of atlantoaxi

关 键 词：颈寰椎 枢椎 关节不稳定性 内固定器 

分 类 号：R687.3[医药卫生—骨科学]