寰枢椎侧块关节内融合术及其融合器的研究进展  

Research progress of intra-articular atlantoaxial mass fusion and its cage

作　　者：刘华 张涛 范槐喜 史田云 王昊 李松凯 Liu Hua;Zhang Tao;Fan Huaixi;Shi Tianyun;Wang Hao;Li Songkai(First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Spinal Surgery,the 940th Hospital of PLA Joint Logistics Support Force,Lanzhou 730050,China)

机构地区：[1]甘肃中医药大学第一临床医学院,兰州730000 [2]中国人民解放军联勤保障部队第九四〇医院脊柱外科,兰州730050

出　　处：《中华骨科杂志》2024年第24期1619-1627,共9页Chinese Journal of Orthopaedics

摘　　要：寰枢椎后路融合术是治疗寰枢椎脱位的主要手段。目前的寰枢椎侧块关节内融合具有更高的骨融合率、更少的植骨量及更低的并发症。寰枢椎侧块关节内融合器目前在临床已开始应用,但仍未广泛普及。寰枢椎失稳及可复性寰枢椎脱位可采用单纯后路复位、固定及寰枢椎侧块关节内融合;对部分难复性寰枢椎脱位患者,如严重颅底凹陷及前方异常骨性结构阻挡复位等,经口松解是必要的手术方式,经口置入前路融合器也是可行的方式。无论是后路还是前路的寰枢椎侧块关节内融合术都在术式、植骨材料及融合器等方面进行了改进。其中术式由经典的开放入路变得更微创;植骨由大块髂骨、颗粒状松质骨、腓骨、到C 1后弓及C 2椎板采集的自体骨,再到同种异体骨,植骨材料的选择越来越多样化;融合器由垫片衍生出钛块,继而发展为适应寰枢关节解剖结构、骨融合率高、宽度与高度规格多样的融合器。前路融合器中,圆形融合器置入简单,楔形融合器经口置入更贴合寰枢侧块关节生理结构,可达到更佳的手术效果;3D打印锁定融合器可为固定和融合提供强大的前部支撑且无须植骨。前路融合器适合部分难复性寰枢椎脱位需经口松解的患者。后路融合器中,圆柱形螺纹状融合器可提供即刻的稳定性,个性化定制融合器受力更均匀且能减少融合器下沉。后路融合器适用性广,适合颅底凹陷及寰枢椎脱位的患者。融合器、植骨材料及术式的不断精进将从稳定性、安全性及融合率多方面优化寰枢椎侧块关节内融合术。An essential treatment for atlantoaxial dislocation is posterior atlantoaxial fusion.The current intra-articular fusion of the atlantoaxial lateral mass joint demonstrates a higher bone fusion rate,requires a smaller amount of bone graft,and has a lower incidence of complications.Although it has been employed in clinical practice,the atlantoaxial lateral mass intra-articular fusion cage is not yet widely utilized.Atlantoaxial instability and reducible atlantoaxial dislocation can be managed with simple posterior reduction,fixation,and atlantoaxial lateral mass intra-articular fusion.For patients with irreducible atlantoaxial dislocation,such as those with severe basilar invagination or obstructive anterior bone structures,transoral release is necessary,and anterior fusion cage placement is also feasible.Both posterior and anterior atlantoaxial lateral mass intra-articular fusion have seen significant improvements in surgical techniques,bone graft materials,and fusion cages.Among them,the procedure is evolving from the classic open approach to a more minimally invasive one.Bone graft materials include massive iliac bone,granular cancellous bone,fibula,autologous bone harvested from the C 1 posterior arch and C 2 lamina,and allogeneic bone,reflecting an increasingly diverse selection.Fusion cages have evolved from simple spacers to titanium blocks and further to cages that are anatomically adapted to the atlantoaxial joint,offering high bone fusion rates and various specifications of width and height.In anterior fusion cages,the circular design facilitates easy placement,while the wedge-shaped cage,when inserted transorally,better conforms to the physiological structure of the atlantoaxial lateral mass joint,resulting in improved surgical outcomes.The 3D-printed locking cage provides robust anterior support for fixation and fusion without the need for additional bone grafting.Anterior fusion cages are particularly suitable for patients with partial irreducible atlantoaxial dislocation requiring transoral release.Po

关 键 词：颈寰椎 枢椎 颈椎 脱位 脊柱融合术 融合器 

分 类 号：R68[医药卫生—骨科学]