术中CT辅助椎弓根螺钉内固定治疗寰枢椎不稳疗效分析  

Analysis of the therapeutic effect of pedicle screw internal fixation combined with intraoperative CT in the treatment of atlantoaxial instability

作　　者：高利峰[1] 刘雅普[1] 李鹏[1] 侯秀伟[1] 徐永辉[1] 郑笑臣 吴广良[1] GAO Li-feng;LIU Ya-pu;LI Peng;HOU Xiu-wei;XU Yong-hui;ZHENG Xiao-chen;WU Guang-liang(Spinal Surgery Department,Second Affiliated Hospital of Henan Luohe Medical College,Luohe,Henan 462300,China)

机构地区：[1]河南省漯河医学高等专科学校第二附属医院脊柱外科,河南漯河462300

出　　处：《颈腰痛杂志》2024年第4期657-660,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：河南省教育厅高校重点科研项目(编号:21B320004)。

摘　　要：目的探讨椎弓根螺钉内固定联合术中CT扫描治疗寰枢椎不稳的临床疗效。方法对该院2015年7月~2019年11月采用术中CT辅助后路经寰枢椎椎弓根螺钉内固定结合术治疗的25例寰枢椎不稳患者进行回顾分析,其中22例为寰枢椎不稳或脱位,3例为新鲜的齿状突骨折、脱位;16例患者合并颈脊髓受压症状。22例术中行寰枢椎固定后植骨融合术,3例仅行内固定而未植骨融合。结果25例患者均成功完成手术,寰枢椎各50枚螺钉,术中CT扫描后修正定位针10枚,调整后植入螺钉,术中CT扫描、术后CT重建示螺钉位置均良好;术中、术后均未发现椎动脉、脊髓、神经根损伤等严重并发症发生。术后6个月复查示植骨融合满意,未植骨融合的3例患者均于术后10个月确认骨折愈合后取出内固定物。术后CT重建显示,螺钉位置Gertzbein分级为0级96枚、1级4枚;经Kappa一致性检验,术中CT扫描和术后CT重建显示的螺钉位置Gertzbein分级结果具有非常好的一致性(Kappa=1)。16例合并颈脊髓症状患者的术前JOA评分为(11.3±0.9)分,术后6个月改善为(14.6±0.8)分,术后1年为(15.3±0.8)分,差异有统计学意义(P<0.05)。结论术中CT辅助椎弓根螺钉治疗寰枢椎不稳可以提高置钉的精准性和手术安全性,可以更好地判断寰枢椎复位,取得良好的临床疗效。Objective To explore the clinical efficacy of pedicle screw fixation combined with intraoperative CT scanning in the treatment of atlantoaxial instability.Method A retrospective analysis was conducted on 25 patients with atlantoaxial instability treated with posterior transpedicular screw fixation and intraoperative CT scanning from July 2015 to November 2019,22 cases were old instability or dislocation of the atlas axis while 3 cases were fresh fractures or dislocations of the odontoid process.22 cases underwent intraoperative atlantoaxial fixation followed by bone graft fusion,while 3 cases only underwent internal fixation without bone graft fusion.Results All 25 patients successfully completed the surgery,with 50 screws in each atlas and axis.During the surgery,10 positioning pins were corrected after CT scanning,and screws were implanted after adjustment.Both intraoperative CT scanning and postoperative CT reconstruction showed good screw positions;No serious complications such as vertebral artery,spinal cord,or nerve root injuries were found during or after the surgery.A follow-up examination at 6 months after surgery showed satisfactory bone graft fusion.All 3 patients without bone graft fusion were removed with internal fixators after confirming fracture healing at 10 months after surgery.Postoperative CT reconstruction showed that the Gertzbein grading of screw positions was 96 at level 0 and 4 at level 1;After Kappa consistency test,the Gertzbein grading results of screw positions displayed on intraoperative CT scans and postoperative CT reconstruction showed very good consistency(Kappa=1).The preoperative JOA score of 16 patients with cervical spinal cord symptoms was(11.3±0.9),the improvement was(14.6±0.8)at 6 months after surgery,and(15.3±0.8)at 1 year after surgery,with a statistically significant difference(P<0.05).Conclusions Intraoperative CT assisted pedicle fixation can improve the accuracy and surgical safety of screw implantation.The reduction of the atlantoaxial spine can be better judged,

关 键 词：寰枢椎不稳 椎弓根螺钉 术中CT 内固定 植骨 

分 类 号：R687.3[医药卫生—骨科学]