经C_(1、2)关节突螺钉治疗寰枢椎创伤和不稳的疗效及手术策略

Effect and Operation Strategy for Posterior C_(1、2) Transarticular Screw Fixation for Atlantoaxial Trauma or Instability

目的探讨经C1、2关节突螺钉治疗寰枢椎创伤和不稳的疗效及手术策略。方法11例寰枢椎骨折或不稳需行寰枢椎融合患者,经颅骨牵引基本复位后行C1、2关节突螺钉联合Gallie手术,观察术后近期疗效、植骨融合及并发症。结果术中和术后无神经、椎动脉损伤表现。术后枕颈部冬痛消失7例,明显缓解4例。1例双上肢麻木术后明显好转。过伸过屈侧位X线片示寰枢椎稳定性好。平均随访7.8个月,11例植骨均融合,无内固定并发症。颈椎前屈、后伸、左右侧屈活动度未见明显减少,旋转活动平均丧失34.6%。结论经C1、2关节突螺钉固定寰枢椎生物力学稳定性好,植骨融合率高,并发症发生率低,是一种安全、疗效可靠的手术方法。

Objective To evaluate the effect of posterior C1、2 transarticular screw fixation for atlantoaxial trauma or instability and propose the operation strategy. Methods Postoperative effect, bone fusion and complications of eleven patients undergoing posterior C1、2 transarticular screw fixation after reduction by skull traction were observed. Results Bone fusion was achieved in all patients and no one had any nerve and vertebral artery injury. Pain disappeared in seven patients and improved in four patients postoperatively. Numbness of both upper limbs in one patient markedly improved. X - rays showed the stability of the atlantoaxis. The degree of flexion, extension and side flexion was not markedly decreased, but the degree of rotation was decreased by 34.6 % on average. Conclusion Posterior C1、2 transarticular screw fixation for atlantoaxial trauma or instability with the high bone fusion rate and the low complication rate is a safe, efficient surgery technique in stabilization of atlantoaxis.