后路寰枢椎椎弓根螺钉固定治疗创伤性寰枢椎不稳的临床研究  

Posterior atlantoaxial transpedicle screw fixation for traumatic atlatoaxial instability

作　　者：王正雷 孙鹏 张文进 李阳 刘建辉 郭宁 孔军 范文宪 宫明 齐琦 于洋 

机构地区：[1]解放军211医院骨二科,哈尔滨150080

出　　处：《解放军医学杂志》2015年第9期754-757,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨颈椎后路寰枢椎椎弓根螺钉固定技术治疗创伤性寰枢椎不稳的临床疗效。方法回顾性分析2009年9月-2013年3月在解放军211医院采用颈椎后路寰枢椎椎弓根螺钉固定技术治疗的17例创伤性寰枢椎不稳患者的临床资料,其中男12例,女5例,年龄19～63岁,平均42岁,寰枢椎骨折脱位8例,寰椎横韧带断裂2例,齿状突骨折7例,术前神经功能JOA评分为5.0～14.0分,平均11.2分。术前均行颈椎X线片、CT、MRI等影像学检查。结果术中无椎动脉、脊髓和神经根损伤发生。17例患者均完全复位,术后第1天在颈托保护下下床活动。术后随访6～36个月,平均21个月,临床症状明显改善。术后6个月时复查影像学检查显示所有螺钉位置良好,植骨愈合良好,无内置物松动、断裂。术后12个月JOA评分为11.0～17.0分,平均15.5分,与术前比较差异有统计学意义（P〈0.05）。结论采用寰枢椎椎弓根螺钉固定技术治疗创伤性寰枢椎不稳安全可靠,疗效满意。Objective To explore the clinical efficacy of posterior atlantoaxial pedicle screw fixation for traumatic atlantoaxial instability. Methods From September 2009 to March 2013, 17 patients with atlantoaxial instability received posterior atlantoaxial pedicle screw fixation. There were 12 males and 5 females, with a mean age of 42 years old （ranged from 19 to 63 years old）. Transpedicle screw fixation was employed in 8 patients with atlantoaxial fracture and dislocation, in 2 with traumatic disruption of transverse atlantal ligament, and in 7 with odontoid fracture. The Japanese Orthopaedic Association （JOA） score before operation was from S to 14, with a mean of 11.2. Preoperative CT, MRI and radiographs, as well as intraoperative screw placement and bone graft were administered in all the patients. Results In all the patients, complete reduction was achieved without injury to the vertebral artery, spinal cord or never root, and they started to be ambulatory on the first day after the operation. The patients were followed up for 6-36 months （mean 21 months）, and clinical symptoms were seen to be improved significantly. Imaging re- examination 6 months after the surgery showed satisfactory healing of implanted bone and position of all the screws without loosening of the implant. The mean JOA scores was 15.3（11.0-17.0） twelve months after the operation. Conclusion Atlantoaxial pedicle screw fixation for traumatic atlantoaxial instability is safe and reliable with a favorable clinical result.

关 键 词：寰枢椎不稳 椎弓根螺钉 矫形外科手术 

分 类 号：R687.37[医药卫生—骨科学]