寰枢椎椎弓根固定技术在C1／2骨折脱位中的应用

Fixation of pedicle of vertebral arch in treatment of atlantoaxial fractures and dislocation： analysis of 24 cases

目的探讨经寰枢椎椎弓根内固定技术的技巧与临床疗效。方法对24例寰枢椎脱位并由高位颈髓受压症状及体征的患者行寰枢椎椎弓根固定技术治疗，术前均行X线、CT等影像学检查，术中直视下行C1、C2置钉，复位、固定，椎板后弓植骨。其中12例前路下颌下松解，一期经寰枢椎椎弓根复位固定，术后颈托固定3个月。结果24例84牧螺钉均成功置入，复位固定满意。术后22例获3～48个月的随访，平均18．9个月，患者在4～6个月骨性愈合，未发现螺钉松动、断钉、寰枢椎再次脱位现象。其中有4牧螺钉穿入椎动脉孔内缘0．5～1．0mm，但无椎动脉损伤临床表现。22位患者脊髓功能明显改善。结论经寰枢椎椎弓根内固定技术具有直视下置钉，短节段固定，术中复位，融合率高特点，为寰枢椎骨折脱位患者治疗提供了一种较好的内固定术式。

Objective To explore the effects of fixation of pedicle of vertebral arch in treatment of atlantoaxial fractures and dislocation. Methods Pedicle screw instrument was used in fixation of pedicle of vertebral arch in 24 patients with atlantoaxial fractures and dislocation. Twelve cases with irreducible atlas dislocation were treated surgically with anterior soft tissue release combined with posterior reduction and pedicle screw instrument. Preoperative CT and radiography as well as intraoperative screw placement and bone grafting were administered in all cases. Cervical collar was as external support for 3 months. Result A total of 84 screws were successfully placed in the atlas. 22 of the 24 cases were followed up for 18.9 months （3 -48 months） without the complication of internal fixation failure. Bony union occurred within 4 - 6 months without the complications of internal fixation, fixation failure, and re-dislocation. Four screws were penetrated into the medial rim of the vertebroarterial foramen; however, no vertebral artery injury was documented. Neurological recovery was improved significantly in 22 cases. Conclusion With the advantages of screw placement under direct vision, short-segment fusion, intra-operative reduction, and high fusion rate, internal fixation through pedicle of vertebral arch is a good method for atlantoaxial fractures and dislocation.