采用椎弓根螺钉内固定治疗寰枢椎骨折脱位  

Transpedicular screw fixation for the treatment of atlantoaxial fracture and dislocation

作　　者：王正雷 王海斌 刘建辉[1] 张文进[1] 郭宁[1] 范庆建 宫明 荀琳 WANG Zheng-lei;WANG Hai-bin;LIU Jian-hui;ZHANG Wen-jin;GUO Ning;FAN Qing-jian;GONG Ming;XUN Lin(Department of Orthopaedics,No.962 Hospital of PLA,Harbin 150080,China)

机构地区：[1]中国人民解放军第962医院骨二科,哈尔滨150080

出　　处：《中国矫形外科杂志》2020年第10期933-935,共3页Orthopedic Journal of China

摘　　要：[目的]探讨寰枢椎椎弓根螺钉技术治疗创伤性寰枢椎不稳的临床效果。[方法]2009年9月~2017年3月,对6例创伤性寰枢椎不稳患者采用颈椎后路寰枢椎椎弓根螺钉固定技术治疗。术前均常规行颅骨牵引,椎弓根进钉点位于寰椎椎弓两侧距后结节20 mm、后弓下缘2 mm,内倾5°~10°、头倾10°~15°,置入直径3.5 mm、长22~26 mm螺钉。枢椎螺钉的进钉点位于侧块内上象限,内倾约25°,头倾约25°置入直径3.5 mm、长24~28 mm螺钉。[结果]术中无血管及神经损伤。术后随访6~36个月,患者临床症状得到明显改善。术后检查显示螺钉位置良好,无内置物松动、断裂。术后12个月JOA评分为11.00~17.00分。[结论]寰枢椎椎弓根螺钉固定治疗创伤性寰枢椎不稳疗效满意。[Objective]To introduce surgical technique and primary outcomes of atlantoaxial pedicle screw fixation for atlantoaxial fracture and dislocation.[Methods]From September 2009 to March 2017,a total of 6 patients with atlantoaxial fracture and dislocation were treated with transpedicular screw fixation.Under skull traction,a midline incision from the occipital protuberance to C3 was made to expose the posterior arch of atlas and axial spinous process and lamina.The C1 pedicle screws of3.5 mm in diameter and 22~26 mm in length were inserted at the lateral masses 20 mm to the posterior tubercle and 2 mm to the inferior edge of posterior arch,with 5°~10°inward and 10°~15°cephalic tilting,while the C2 screws of 3.5 mm in diameter and 24~28 mm in length were placed at the superomedial quadrant of lateral mass,with 25°inward and 25°cephalic inclining.Finally,two pre-curved rods were placed and fixed with the pedicle screws bilaterally.[Results]All the patients had surgical procedures performed smoothly without injuries of vertebral artery,spinal cord or never root.The patients were followed up for6~36 months,and achieved significant improvement in clinical presentations.At 6 months after operation,radiographic examination revealed that all patients had implants kept in proper position,with sound fusion of the spine,while without loosening or breaking of the implant in anyone of them.The JOA scores proved of 11.00~17.00 at 12 months postoperatively.[Conclusion]Atlantoaxial pedicle screw fixation is safe and reliable for atlantoaxial fracture and dislocation.

关 键 词：寰枢椎 骨折 脱位 椎弓根螺钉 

分 类 号：R683.2[医药卫生—骨科学]