经寰枢椎椎弓根内固定植骨融合术治疗寰枢椎不稳

Bone graft Arthrodesis with Screw-plate System by Atlantoaxial Pedicle for Treatment of Atlantoaxial Instability

目的探讨经寰枢椎椎弓根钉板内固定植骨融合术治疗寰枢椎不稳的近期疗效观察。方法12例中Ⅱ型陈旧性齿状突骨折5例,齿状突不连3例,横韧带损伤4例。采用经寰枢椎椎弓根置入螺钉,以连接板将寰枢椎固定螺钉锁定,使寰枢椎得到稳定,在寰枢椎后弓间植入颗粒状骨。结果12例全部得到随访,平均随访10·5个月,均获骨性融合。1例术后出现枕大神经疼痛,经治疗1个月后痊愈。9例脊髓功能明显改善,2例略有改善,1例无变化。结论采用寰枢椎椎弓根钉板固定可以使寰枢椎即刻得到坚强的三维稳定,是一种值得推广应用的手术方法。

Objective To report the result of a newly designed screw - plate system for the treatment of atlantoaxial instability. Methods Twelve patients, comprising 5 patients with type Ⅱ old fracture of odontoid process, 3 with asynthesis of odontoid process and 4 with injury of horizontal ligament were included. Two screws were screwed into atlantoaxial joint through the pedicels. Two plates were placed to connect the screws of each side and locked by nuts to stabilize the atlas and axis. Then the granulated autogenous cancellous bone was placed onto the surface of the posterior arches of both atlas and axis. Results Twelve patients undergoing the procedure described above and followed up for the mean period of 10.5 months obtained atlantoaxial arthrodesis. Pain of the greater occipital nerve occurred in 1 patient after the operation and was completely relieved by treatments after 1 month. The myelopathy recovered remarkably in 9 patients, slightly in 2 and remained unchanged in 1. Conclusion Screws and plates in the pedicles of atlas and axis can make the atlantoaxial joint stable in three - dimension immediately. This procedure is worth promoting.