后路融合固定术治疗创伤性寰枢椎不稳与脱位

Treatment of posterior arthrodesis with internal fixation for the atlanto-axial instability or dislocation caused by injury

目的 探讨后路融合固定术治疗创伤性寰枢椎不稳与脱位的临床疗效及手术方式的选择。方法 对2 3例创伤性寰枢椎不稳与脱位的后路手术治疗进行分析。10例寰枢椎不稳及7例可复性寰枢椎脱位,行寰枢椎内固定、植骨融合术;6例不可复性寰枢椎脱位,行寰椎后弓切除减压、枕颈融合术。结果 1例可复性寰枢椎脱位于术后1周死亡;1例术后脱位复发,症状未改善。其余病例随访5个月～5年,枕颈部症状减轻或消失,神经系统症状有不同程度改善;寰枢椎或枕颈部植骨于3～6个月骨性融合;无内固定物松动、断裂。结论 后路融合固定术是治疗创伤性寰枢椎不稳与脱位的有效方法。术前应仔细分析创伤性寰枢椎不稳或脱位的特点。

Objective To investigate the results of posterior arthrodesis for treatment of the atlanto-axial instability or dislocation caused by injury,and discuss operation method.Methods Ten cases of the atlanto-axial instability and 7 cases of the reducible atlanto-axial dislocation were treated by arthrodesis with internal fixation and bone grafting posteriorly at atlanto-axial position.Six cases of the irreducible atlanto-axial dislocation were decompressed by resecting the atlantal arch and internal fixation and bone grafting between occiput and atlas.Results One reducible dislocation case died,and redislocation occurred in 1 reducible dislocation case,the others were followed up for an average 26 months (ranged 5 months to 5 years).All 22 cases undergoing fusion achieved bony union in 3-6 months after surgery.The symptom of local ache and nervous system recovered in different extends.Conclusion It is an effective method to treat the atlanto-axial instability or dislocation by posterior arthrodesis,and it is important to be familiar with clinical features before surgery.