后路切开复位钉板内固定治疗寰枢椎失稳  

Open reduction with pedicle screw-plate internal fixation via posterior approach for treatment of atlantoaxial joint instability

作　　者：莫飞炜 贾世青 刘昌生[1] 谢新景[1] 宁运乾[1] 赖英静 朱允滔 MO Fei-wei;JIA Shi-qing;LIU Chang-sheng;XIE Xin-jing;NING Yun-qian;LAI Ying-jing;ZHU Yun-tao(SectionⅠ,Dept of Spine,Yulin Orthopaedics Hospital of Chinese and Western Medicine,Yulin,Guangxi 537000,China)

机构地区：[1]玉林市中西医结合骨科医院脊柱一科,广西玉林537000

出　　处：《临床骨科杂志》2022年第3期305-309,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨后路切开复位钉板内固定治疗寰枢椎失稳的临床疗效。方法采用后路切开复位钉板内固定治疗17例寰枢椎失稳患者。记录手术时间、术中出血量、植骨融合情况、神经功能改善情况以及并发症发生情况,测量寰枢椎水平的椎管矢状径以了解寰枢椎复位情况。结果患者均获得随访,时间9~24个月。手术时间90~195 min;术中出血量50~500 ml。植骨融合率17/17。术后寰枢椎均复位效果良好,无明显复位丢失,螺钉位置良好。术后均未发生内固定松动、断裂等并发症。3例术前无神经症状的患者术后均未发生神经功能方面并发症;14例术前有神经症状的患者术后均明显好转。寰枢椎水平的椎管矢状径术后、末次随访时均明显大于术前,差异均有统计学意义(P<0.05)。结论采用后路切开复位钉板内固定治疗寰枢椎失稳,可有效恢复椎管容积、改善神经功能、维持寰枢椎稳定,具有固定牢靠、操作安全的优点。Objective To investigate the clinical effect of open reduction with pedicle screw-plate fixation via posterior approach for treatment of atlantoaxial joint instability.Methods The 17 patients with atlantoaxial instability were treated with open reduction with pedicle screw-plate fixation via posterior approach.The surgery time,intraoperative bleeding volume,bone grafting fusion,improvement of neurological function and occurrence of complications were recorded,and the spinal sagittal diameter at the atlantoaxial level was measured to assess the atlantoaxial reduction situation.Results All patients were followed up for 9~24 months.The operation time was 90~195 min;the intraoperative bleeding volume ranged from 50 ml to 500 ml.The bone grafting fusion rate was 17/17.The atlantoaxial vertebrae reduction were good,without obvious reduction loss,and screw position was good.No complications such as internal fixation loosening,fracture occurred after surgery.None of the three patients without preoperative neurological symptoms had postoperative neurological complications;the 14 patients with preoperative neurological symptoms were all improved significantly after surgery.The sagittal diameter at the atlantoaxial level:at the postoperation and last followup,which was significantly bigger than the preoperation,there were statistical differences(P<0.05).Conclusions In the treatment of atlantoaxial instability,open reduction pedicle screw-plae internal fixation with posterior approach can effectively restore the spinal canal volume,improve nerve function,and maintain atlantoaxial stability,with the advantages of firm fixation and safe operation.

关 键 词：寰枢椎关节失稳 椎弓根钉板内固定 

分 类 号：R684.7[医药卫生—骨科学] R687.32[医药卫生—外科学]