寰枢椎经后路椎弓根钉板/棒系统固定融合治疗上颈椎不稳

C_(1,2) pedicle screw internal fixation for atlantoaxial instability

目的探讨和评估寰枢椎椎弓根钉板/棒固定融合治疗上颈椎不稳的临床疗效和应用价值。方法对2005年5月-2007年6月收治的16例寰枢椎不稳患者（其中先天性齿突发育不良2例,创伤性陈旧性寰枢关节脱位6例,C2椎管内肿瘤1例,陈旧性齿突骨折7例）施行后路寰枢椎椎弓根钉棒固定术并行自体髂骨植骨融合,其中1例难复性脱位者先行前路松解术。结果全组病例未发生与置钉相关的并发症;所有病例术后随访12-24个月,临床症状得到不同程度的改善,复查X线片、CT未见上颈椎失稳及复位丢失,螺钉位置良好,无松动、断钉,术后随访效果满意。结论寰枢椎椎弓根钉棒固定治疗上颈椎不稳,效果良好,是寰枢椎后路固定较好的手术方式。

Objective To evaluate the clinical effect and safety of C1, 2 pedicle screw-rods/plates internal fixation for atlantoaxial instability. Methods Sixteen patients with atlantoaxial instability（including 2 cases of congenital dysplasia of odontold process, 6 cases of old traumatic atlanto-axial joint dislocation, 1 case of intraspinal tumor and 7 cases of odontoid process fracture） were treated by C 2 pedicle screw-rods/plates internal fixation and bone graft fusion from May 2005 to June 2007, and 1 Case of irreducible atlantoaxial dislocation among them underwent anterior release first. The immediate outcome and complications were observed. Results There was no vascular or neural injury found. The patients were followed up by 12 to 24 months. The clinical symptom was improved in some extent after operation： There wasno upper cervical instability or reduetion lost according to X-rays and CT, No looseness or breakage of screw occurred and bony fusion was achieved in all cases Conclusion C1,2 pedicle screw-rods/plates internal fixation is a reliable method for atlantoaxial instability which can reestablish the upper cervieal vertebrae stability and help to recover the spinal cord and nerve function.