寰枢椎不稳后路手术固定的研究

Study on the surgical treatment of atlanto-axial instability

目的比较研究寰枢椎不稳后路固定的方法,为寰枢椎不稳患者制定合理的手术方案。方法回顾5年来手术治疗的34例寰枢椎不稳病例,并对几种手术方法的适应证、稳定性和疗效进行比较研究,分析其结果。结果寰枢椎不稳的不同病因采用不同的固定方法临床结果不同。后路钢丝法对齿状突骨折引起的寰枢椎不稳固定效果良好,类风湿关节炎所导致的寰枢椎不稳后路钢丝固定也有好的疗效,但术后需用严格的头颈胸石膏固定。Apofix椎板夹固定与Brooks法固定效果无显著差异。Magerl螺钉是最牢靠的内固定方法。结论寰枢椎不稳采用后路手术固定应根据不同的病因选择不同的固定融合方法和术后辅助外固定。

Objective Through comparing different methods of posterior approach fixation, to find out an ideal way for treating aflanto-axial instability. Methods Thirty-four cases of atlantoaxial instability treated surgically in the last 5 years were reviewed. The indication, stability and curative effect of different surgical treatment methods were studied comparatively and the results were analysed. Results Different methods of fixation resulted in different outcomes according to different causes of aflanto-axial instability. Posterior cable fixation was the suitable method of fixation for atlanto-axial instability caused by odontoid fractures, which was also suitable for atlano-axial instability caused by rheumatoid arthritis but needing rigid head-neckchest combined plaster fixation after operation. There was no significant difference between Apofix and Brooks fixation. The most reliable method of fixation was with Magerl screw system. Conclusion According to the different causes of atlanto-axial instability, posterior approach fixation should choose different methods of fusion and assisted external fixation.