改良枢椎峡部螺钉技术在难复性寰枢椎脱位三维复位中的优势与临床疗效  

Clinical advantage and outcome of modified C2 isthmus screw in three-dimensional reduction of irreducible atlantoaxial dislocation

作　　者：苑博 周盛源 唐一钒 赵寅 陈雄生 YUAN Bo;ZHOU Shengyuan;TANG Yifan;ZHAO Yin;CHEN Xiongsheng(Spine Center,Department of Orthopaedics,Shanghai Changzheng Hospital,Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院(上海长征医院)脊柱外科,上海200003

出　　处：《中华骨与关节外科杂志》2024年第2期111-117,共7页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:回顾性分析改良枢椎峡部螺钉技术在难复性寰枢椎脱位复位操作中的优势与临床疗效。方法:本研究纳入2011年7月至2021年5月收治的难复性寰枢椎脱位患者28例,男16例,女12例。所有患者均使用改良枢椎峡部螺钉,组合寰椎椎弓根/侧块螺钉进行复位植骨融合。影像结果通过寰齿前间隙(ADI)、纵向脱位比值、颈髓角(CMA)进行评估,临床疗效通过术前和末次随访的日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)和颈部功能障碍指数(NDI)进行评估。结果:患者术后随访28(12,93)个月。患者的寰枢椎脱位在矢状位、冠状位和水平位上均获得有效复位并维持,脊髓压迫解除,植骨融合良好;术后CT未见螺钉刺入椎管或伤及椎动脉。术前与末次随访的ADI、纵向脱位比值、CMA、JOA、NDI和VAS评分差异均有统计学意义(P均<0.001)。无神经损伤和内固定失败等并发症。结论:改良枢椎峡部螺钉技术置钉操作安全,适用于寰枢椎矢状面前后、纵向、成角脱位的三维复位。Objective:To retrospectively analyze the advantages and clinical efficiency of modified C2 isthmus screw technique in the reduction of irreducible atlantoaxial dislocation.Methods:Totally 28 patients with irreducible atlantoaxial dislocation were treated with modified C2 isthmus screw combined with C1 pedicle/lateral mass screw for reduction and fusion.Radiological outcome was evaluated by the anterior-atlas interval(ADI),longitudinal dislocation ratio,and cervicomedullary angle(CMA).Clinical efficacy was investigated by the Japanese Orthopaedic Association(JOA)score,visual analog scale(VAS),and neck disability index(NDI)before and at the last follow-up.Results:A follow-up of 28 months(12,93 months)showed that the atlantoaxial dislocation of all patients was effectively reduced and maintained in sagittal,coronal and horizontal positions.The spinal cord compression was relieved with good bone fusion.Postoperative CT showed no screw insertion into the spinal canal or injury to the vertebral artery.The ADI,longitudinal dislocation ratio,CMA,JOA,NDI and VAS scores at the last follow-up were statistically different from preoperative ones(all P<0.001).No complications occurred,such as intraoperative nerve injury and failure of internal fixation.Conclusions:The modified C2 isthmus screw technique is safe and can effectively complete three-dimensional reduction of atlantoaxial dislocation,especially for patients with anteroposterior,vertical,and angulated dislocation in the sagittal plane.

关 键 词：峡部螺钉 枢椎 寰枢椎脱位 复位 

分 类 号：R687.3[医药卫生—骨科学]