寰枢椎不稳定的手术治疗策略

Operative strategy of atlantoaxial instability

目的:探讨寰枢椎不稳定的手术方法及治疗效果。方法:回顾性分析29例寰枢椎不稳定患者的临床资料,男27例,女2例;年龄18～54岁,平均33岁。寰椎前弓骨折伴横韧带断裂5例,齿状突骨折7例,Hangman骨折6例,枕、寰枢椎发育异常10例,强直性脊柱炎1例。所有患者均有寰枢椎不稳定的临床及影像学表现,其中18例有高位颈脊髓病或脊髓损伤的症状及体征。手术方法:单纯改良Magerl术7例,齿状突中空螺钉内固定6例,前路C2,3间盘切除、植骨Zephir钛板内固定4例,经皮C2椎弓根拉力螺钉固定2例,前路经口咽松解复位加改良Magerl术4例、加后路寰枢侧块钉板固定3例,经枢椎椎弓根的枕颈融合术3例。结果:平均随访17.2个月(11～38个月),29例均达解剖复位,均获骨性融合或愈合。对其中18例术前有脊髓损害患者采用Odom标准评估疗效:优9例,良7例,可2例。本组病例未发生椎动脉、神经根及脊髓损伤和切口感染并发症,无内固定断裂、松动。结论:准确判断造成寰枢椎不稳定的因素,选择合理的手术方案,可取得满意的临床疗效。

Objective ：To evaluate the operative strategy and therapeutic outcomes of the atlantoaxial instability. Methods：Clinical data of 29 patients with atlantoaxial instability were retrospectively analyzed. There were 27 males and 2 females. The mean age was 33 years old with a range from 18 to 54 years. There were fracture of anterior arch of atlas accompanied with ligamentum transversum rupture in 5 cases,odontiod fracture in 7 cases, Hangman fracture in 6 cases,dysplasia of atlas and axis in 10 cases,ankylosing spondylitis in 1 case. The clinical and imaging manifestation of atlantoaxial instability were found in all patients. The symptoms and physical signs of superior cervical spinal cord disease or cervical spinal injury were found in 18 cases. The patients were treated with simple modified Magerl method （7 cases）,cannutated screw fixation（6 cases） ,resection of C2.3 disc throuth the anterior approach and fusion with Zephir titanium plate （4 cases）, percutaneous pedicle screw fixation of C2 （2 cases）,release and reduction through anterior oropharynx （LRAO）combined with modified Maged method （4 eases）,LRAO and atlas lateral mass screw and plate fixation through posterior approach （3 cases） ,cervical occipital fusion through C2 pedicle（3 cases）. Results：All patients were followed up with an average time of 17.2 months ranging from 11 to 38 months. All patients obtained anatomical reduction and bone healing. Using Odom standard to evaluation for 18 cases with spinal injury before operation,the results were excellent in 9 cases,good in 7 ,fair in 2. No injury of vertebral artery,nerve root,spinal cord,infection of ineisional wound,breaking or loosening of internal fixatir were found in the study. Conclusion： Identifying the causes of atlantoaxial instability, rational plan of operation can get satisfactory clinica results.