颈后路寰枢椎钉棒内固定植骨融合术治疗寰枢椎不稳及脱位的疗效分析

Efficacy analysis of posterior screw-rod internal fixation and bone graft fusion for the treatment of atlantoaxiai instability and dislocation

目的探讨采用颈后路寰枢椎钉棒内固定植骨融合术治疗寰枢椎不稳及脱位的临床疗效。方法回顾性研究2014年4月至2015年9月我院采用颈后路寰枢椎钉棒内固定植骨融合术治疗的寰枢椎不稳及脱位病人36例,其中男21例、女15例,年龄为23~65岁、平均(51.3±8.4)岁。术前、术后及随访期间均行颈椎X线、CT及MRI检查,通过术前和末次随访时病人日本骨科协会(Japanese Orthopaedic Association scores,JOA)评分、寰椎平面脊髓有效空间(space available for the spinal cord,SAC)及颈部功能障碍指数(neck disability index,NDI)进行疗效分析。结果 36例病人均顺利完成手术,随访时间为17~35个月,平均26个月。术后呼吸困难1例、脑脊液漏1例、切口渗液感染1例,经对症处理症状后均好转。随访期间,未见内固定失效及寰枢椎再脱位等并发症发生。术后1年时,寰枢椎间植骨均获得较满意的骨性融合。末次随访时,36例病人JOA评分、SAC及NDI分别为(14.36±1.69)分、(14.58±1.86)mm、19.24±7.57,与术前比较均有改善,差异均有统计学意义(均P<0.05)。29例非外伤病人末次随访时颈椎屈伸活动度与术前相比有所改善,但差异无统计学意义(P>0.05);旋转活动度相比术前受限,差异有统计学意义(P<0.05)。结论颈后路寰枢椎钉棒内固定植骨融合术治疗寰枢椎不稳及脱位可有效复位、牢靠固定,且植骨融合率高,临床疗效令人满意。

the treatment of atlantoaxial instability and dislocation.Methods Thirty-six patients with atlantoaxial instability and dislocation were enrolled into a retrospective study,in our hospital between April 2014 and September 2015,and all of them were treated with posterior screw-rod internal fixation and bone graft fusion.These patients included 21 males and 15 females,aged 23-65(51.3±8.4)years.The cervical spine X-ray,CT and MRI scans were performed before and after the operations,and during the follow-up period.The results were analyzed by the Japanese Orthopaedic Society(JOA)score,space available for the spinal cord(SAC)and neck dysfunction index(NDI).Results The 36 operations were completed successfully,and all the cases were followed up from 17 to 35 months(mean 26 months).The JOA score was 9.35±3.54,SAC in atlas level was(8.69±2.32)mm and NDI was 37.46±9.34 preoperatively,and those in the last follow-up were 14.36±1.69,(14.58±1.86)mm and 19.24±7.57 respectively,which were improved significantly with statistical significance(P<0.05).The range of flexion and extension of incervical spine in 29 cases was measured at the final follow-up,which was improved slightly without statistical significance(P>0.05).The range of rotation at the final follow-up was reduced with statistical significance(P<0.05).The postoperative dyspnea was found in 1 case,cerebrospinal fluid leakage in 1 case and infection in 1 case,and these symptoms were alleviated after treatments.There were no complications such as internal fixation failure and atlantoaxial dislocation during the follow-up period.Conclusion The posterior screw-rod internal fixation and bone graft fusion for the treatment of atlantoaxial instability and dislocation can obtain effective reduction and secure fixation,and improve the rate of bone graft fusion,thus,the clinical effect is satisfactory.