少儿寰枢不稳的后路手术治疗

Treatment of Atlanto-axial Instability with Atlanto-axial Arthrodesis Combined with Different Posterior Internal Fixation Apparatus in Children

目的评价少儿寰枢椎不稳后路手术治疗的疗效。方法对63例15岁以下少儿寰枢椎不稳施行钛缆内固定装置或钢丝内固定系统并颗粒状自体松质骨植骨的寰枢椎后路融合术,其中钢丝固定31例,钛缆固定32例。结果2组在平均手术时间、手术出血量的差异有统计学意义(P<0.05)。63例均获得随访,平均随访时间6.1个月。31例钢丝固定中钢丝断裂4例,钢丝松脱2例,25例获骨性融合;32例钛缆固定中钛缆松脱1例,31例获骨性融合,未发生钛缆断裂、脊髓损伤等其他并发症。在术后平均骨性融合时间,2组之间的差异没有统计学意义(P>0.05);在术后骨性融合病例数,2组之间的差异有统计学意义(P<0.05)。结论少儿寰枢椎不稳的后路手术治疗具有良好的固定效果。钛缆内固定系统与钢丝内固定相比较具有手术操作安全、简单、植入方便、内固定坚强牢靠的优点。

Objective To evaluate retrospectively the outcomes of the treatment of atlanto - axial instability with different posterior internal fixation apparatus for atlanto- axial fusion in children. Methods Sixty- three patients of no more than 15 years old with atlanto - axial instability were divided into two groups according to the use of different posterior internal fixation apparatus system. In steel wire group, 31 patients underwent atlanto- axial arthrodesis combined with posterior internal fixation with steel wire and granulated autogenous cancellous bone graft. In titanium cable group, 32 patients underwent aflanto - axial arthrodesis combined with posterior internal fixation with titanium cable and granulated autogenous cancellous bone graft. Results The differences in average operative time and average amount of bleeding in operation between the steel wire group and the titanium cable group were statistically significant （P 〈 0.05）. The average follow- up was 6.1 months （ranging from 6 to 10 months）. In 31 patients with steel wire fixation, several kinds of complications happened, with steel wire breaking in four patients, and loosening of steel wires in two. The graft fusion succeeded in 25 patients without complications, In 32 patients with titanium cable fixation, loosening of titanium cable happened in one patients. Graft fusion succeeded in 31 patients without any complications such as cord injury, cable loosening and breakage. The differences in average postoperative graft bone fusion time between the steel wire group and the titanium cable group were statistically significant （P 〉 0.05）. The differences in the number of patients with postoperative graft bone fusion between the steel wire group and the titanium cable group were statistically significant （P 〈 0.05）. Conclusion The two kinds of different posterior internal fixation apparatus system for atlanto - axial fusion in children can provide feasible, effective and strong fixation for excellent graft fusion. Posterior internal fixation with titanium cable and auto- lilac bone graft fusion has more advantages than posterior internal fixation with steel wire and auto - lilac bone graft fusion with easier and safer manipulation, less bleeding, shorter operation time, fewer complications and higher rate of graft fusion in children.