后路寰椎侧块螺钉结合枢椎椎弓根螺钉融合固定术治疗寰椎横韧带损伤的研究  

Posterior Atlas Lateral Mass Screw Combined with Axis Pedicle Screw Fixation for the Treatment of Transverse Atlantal Ligament Injuries

作　　者：汤华良 卢德慧 谭铭[1] 李焱[1] 康辉 TANG Hualiang;LU Dehui;TAN Ming;LI Yan;KANG Hui(Department of Orthopaedics,Peoples Hospital of Jiayu County,Xianning Hubei 437200,Chin)

机构地区：[1]嘉鱼县人民医院骨科,湖北咸宁437200 [2]解放军武汉总医院骨科

出　　处：《华南国防医学杂志》2018年第7期450-452,472,共4页Military Medical Journal of South China

基　　金：湖北省卫计委资助项目(WJ2017H0042)

摘　　要：目的探讨寰椎侧块螺钉结合枢椎椎弓根螺钉融合固定术治疗寰椎横韧带损伤的适应症并评价其临床应用价值。方法本组共收治寰椎横韧带损伤患者36例,其中新鲜损伤20例,陈旧性损伤16例。9例伴有寰椎骨折、寰枢椎旋转不稳的患者行颅骨牵引,其中8例伴有不同程度的神经功能损害。按Frankel分级,其中C级2例,D级6例。本组患者颈椎X线检查提示寰齿间距(atlanto dental interval,ADI)4.5~12 mm,平均7.8 mm。所有患者均行寰椎侧块螺钉结合枢椎椎弓根螺钉融合固定术。结果随访所有患者6~27个月,平均15个月,X线检查提示植骨融合良好,寰枢椎稳定性好,无螺钉松动等并发症。术后神经功能恢复按Frankel分级:C级2例,其中1例恢复至D级、1例恢复至E级;D级6例,其中5例恢复至E级、1例神经症状无变化。结论寰椎侧块螺钉结合枢椎椎弓根螺钉融合固定术治疗寰椎横韧带损伤,固定强度高、稳定性好、植骨融合可靠,是一种有效的治疗方法。Objective To investigate the indications of posterior atlas lateral mass screw combined with axis pedicle screw fixation for the treatment of transverse atlantal ligament injuries,and evaluate the clinical application value. Methods A total of 36 patients with transverse atlantal ligament injuries were included,in which 20 were fresh injuries and 16 were chronic.Nine patients with atlas fractures and atlantoaxial rotatory instability were performed with skull traction. Among them,8 cases were accompanied with different degrees of neurological impairment. According to Frankel classification,there were 2 cases of grade C and 6 cases of grade D. The X-ray examination of cervical spine in this group revealed the atlanto-dental interval（ ADI）were 4. 5 to 12 mm with an average of 7. 8 mm. All patients underwent lateral atlas lateral mass screw combined with axis pedicle screw fixation. Results All patients were followed up for 6 to 27 months,averaged 15 months. X-ray examination showed there were all good fusion of the bone graft fusion,high atlantoaxial stability,and no complications such as screw loosening. Postoperative neurological function recovery was evaluated by Frankle classification： 2 cases of Grade C,one of them recovered up to Grade E,the other one recovered to Grade D; 6 cases of Grade D,5 cases of them recovered up to Grade E,the other one had not changed in neurologic symptoms. Conclusion Combination of atlas lateral mass screw and axis pedicle screw fixation is an effective treatment for transverse atlantal ligament injuries,which has high fixation strength,good stability,and reliable bone graft fusion.

关 键 词：横韧带 寰椎 侧块螺钉 椎弓根螺钉 

分 类 号：R686.5[医药卫生—骨科学]