双侧寰椎椎板钩及枢椎椎弓根内固定在寰枢椎融合术中的初步应用

Posterior atlantoaxial fusion using bilateral C_1 hook combined with C_2 isthmic screws connected by rods plus autogenous bone

目的初步评价双侧寰椎椎板钩及枢椎椎弓根内固定技术治疗寰枢椎脱位的临床效果。方法2004年10月～2007年2月,采用自体髂骨植骨、双侧寰椎椎板钩及枢椎椎弓根内固定技术共治疗寰枢椎脱位21例,男14例,女7例。其中,陈旧性齿突骨折11例,齿突游离小骨6例,横韧带断裂4例。术前ASIA（American spinal injury association）脊髓神经功能分级（2000年修订）：C级3例;D级12例;E级6例。结果随访3～25个月,平均随访8个月。21例均获得骨性融合。术后ASIA脊髓神经功能分级：D级5例;E级16例。无患者因手术操作致椎动脉和脊髓损伤。结论与传统寰枢椎后路融合术相比,本术式操作简便易行,生物力学稳定性良好,植骨融合率高,且能够在术中对寰枢椎进行加压复位,有利于提高术后临床疗效。该术式在寰枢椎融合术中具有较高的推广应用价值。

Objective To evaluate clinical outcome of a novel posterior atlanto-axial fuse technique composed with bilateral C1 laminar hooks and C2 isthmic screws. Methods From Oct. 2004 to Feb. 2007, twenty-one patients with C1,2 instability, including 14 men and 7 women, were managed with the novel fuse technique. Eleven cases were obsolete odontoid fractures, 6 cases were os odontoideum and 4 cases were traumatic rupture of the transverse ligament. Preoperative ASIA ranking were C degree in 3 cases, D degree in 12 cases and E degree in 6 cases. Results The average followed-up was 8 （3-25） months. All cases achieved excellent bony fusion. Postoperative ASIA ranking were D degree in 5 cases, E degree in 16 cases. There are no complication. Conclusion Compared to traditional posterior atlanto-axial fuse techniques, bilateral C1 hooks combined with C2 isthmic screws connected by rods plus autogenous bone is more stable in biomechanics, and it has excellent bony fusion and clinical outcome. Thus, the novel fixation technique is a promising internal fixation technique.