单纯后路寰枢椎椎弓根螺钉系统治疗创伤性上颈椎不稳  

Treatment of traumatic upper cervical instability with single posterior atlantoaxial pedicle screw system

作　　者：张育锋[1] 钟志刚[1] 沈晖扬[1] 邱雪立[1] 林本丹[1] 

机构地区：[1]中山大学附属汕头医院骨科,汕头515031

出　　处：《中华创伤杂志》2015年第5期418-422,共5页Chinese Journal of Trauma

摘　　要：目的 探讨单纯应用寰枢椎椎弓根螺钉内固定、植骨融合治疗创伤性上颈椎不稳的临床疗效. 方法 2009年10月-2013年8月采用后路寰枢椎椎弓根螺钉内固定技术治疗创伤性上颈椎不稳患者29例.所有患者均行植骨融合,自体植骨19例,同种异体骨10例.统计术中出血量、手术时间、有无神经、血管、脊髓损伤,切口愈合和术后植骨融合情况. 结果 所有患者均顺利完成手术,平均手术时间110 min（85～ 135 min）,平均术中出血量150 ml（80 ～ 500 ml）.经术后10个月～5年随访（平均18个月）,均获得骨性融合.术后X线片显示颈椎稳定,未见复位丢失,亦未见内固定松动退出或断钉.患者均未出现椎动脉及脊髓损伤等并发症,但1例出现切口低毒力感染,2例出现切口延迟愈合. 结论 创伤性上颈椎不稳患者单纯采用寰枢椎椎弓根螺钉内固定置钉安全可行,固定可靠,出血量少,手术时间短,但须注意切口愈合问题.Objective To investigate the clinical efficacy of atlantoaxial pedicle screw fixation plus bony fusion in treatment of traumatic upper cervical instability.Methods From October 2009 to August 2013,29 patients with traumatic upper cervical spine instability were treated with posterior atlantoaxial pedicle screws.The patients underwent autografting （n =19） and allografting （n =10） for spinal fusion.Surrcal outcomes were recorded including intraopcrativc blood loss,operation time,with or without nerve,blood vessel and spinal cord injury,wound healing and bone fusion rate.Results All operations were completed smoothly with operation time of 110 minutes （range,85-135 minutes） and blood loss of 150 ml （range,80-500 ml）.At the follow-up of 10 months to 5 years （mean 18 months）,bony fusion was detected for all the patients.Postoperative radiographs verified all patients were bony fusion with satisfactory cervical spine stability.No complications of reduction loss,fixation failure,and spinal cord or vertebral artery injury were observed except for 1 patient with low viruleut infection and 2 with delayed wound healing.Conclusion Single posterior atlantoaxial pedicle screw fixation provides security and reliable stability in treatment of upper cervical instability,however wound healing problems should be taken seriously.

关 键 词：枢椎 脊柱损伤 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]