后路寰椎侧块和枢椎椎弓根螺钉内固定治疗寰枢椎不稳的疗效观察  

Analysis of efficacy by posterior C1 lateralis mass and C2 pedicle screw for atlantoaxial instability

作　　者：刘纪恩[1] 郝少飞[1] 勾瑞恩[1] 冯伟[1] 

机构地区：[1]郑州市第一人民医院脊柱外科,郑州450004

出　　处：《医药论坛杂志》2015年第12期47-51,共5页Journal of Medical Forum

摘　　要：目的 观察经后路寰椎侧块和枢椎椎弓根螺钉内固定治疗寰枢椎不稳的疗效。方法 回顾性分析应用寰椎侧块和枢椎椎弓根螺钉内固定系统治疗寰枢椎不稳21例患者的效果。本组病例男15例,女6例;年龄29-78岁,平均41岁;包括陈旧性枢椎齿状突骨折15例,齿状突横韧带断裂不稳2例,齿状突游离小骨4例。8例伴有不同程度脊髓受压损伤症状,按ASIA分级8例均为D级。术前均采用颅骨牵引,达到复位或基本复位后再手术。术后影像学观察,同时按JOA评分、SF-36生活质量评分及ASIA脊髓损伤分级评估患者的手术疗效。结果 术后随访6-48个月,平均18个月。本组病例均获得良好的寰枢椎稳定效果,症状缓解,术中无脊髓、椎动脉及神经根损伤。JOA评分1年平均改善率82.26%,有效率100%,优良率85.71%。SF-36生活质量评分有明显提高,8例有神经症状患者均有不同程度恢复。结论 经颅骨牵引复位联合寰椎侧块及枢椎椎弓根螺钉内固定技术是治疗寰枢椎不稳的有效方法,复位及内固定作用确实,稳定性好,寰枢椎植骨融合率高。Objective To abserve the efficacy of posterior C1 lateralis mass and C2 pedicle screw for atlantoaxial instability. Methods Retrospect from April 2011 to December 2014,21 patients（ 15 males and 6 females; aged 29 – 78 years,mean age of 41 years） who demonstrated clinical and radiographic evidence of atlantoaxial instability underwent C1 lateral mass and C2 pedicle screw internal fixation. The cause of instability was that neglected fracture of odontoid peg in 15 patients,ligamentum transversum fractures in 2 patients,and odontoid dissociation bonelet in 4 patients among the total. 8 patients had the symptom of spinal cord compression. Accroding to ASIA rank,all the 8 patients ranked D.All the patients received operation after skull traction reaching reset or basic reset preoperatively. Postoperatively,the radiological observation and the rating criteria of the Japanese Orthopaedic Association（ JOA）. the Short Form（ SF-36） Health Survey Questionnaire and the ASIA rank were used to evaluate the efficacy of the surgery. Results The average follow- up period was 1. 5 years（ range,6 months- 4 years）. All these patients achieved satisfactory results with atlantoaxial stability and symptom released. Moreover,no spinal cord,vertebral artery and nerve root was hurt in the operation. In 1- year follow- up,the average symptom relief rate of JOA was 82. 26%,efficacy rate was 100%,and excellent and good rate was 85. 71%,SF- 36 Health Survey significantly improve and the symptom of spinal cord compression in the 8 patients effectively alleviate. Conclusion It was an effective method to treat atlantoaxial instability that posterior C1 lateralis mass and C2 pedicle screw internal fixation after skull traction reduction,which had reduction and internal fixation,stability was well,and the atlantoaxial fusion rate was high.

关 键 词：寰枢椎不稳 侧块 椎弓根 内固定 

分 类 号：R681[医药卫生—骨科学]