经皮前路侧块螺钉内固定技术在治疗上颈椎骨折中的应用

Application of Percutaneous Anterior Lateral Mass Internal Fixation in C_(1-2) Cervical Vertebral Fracture

目的应用前路经皮侧块螺钉内固定治疗寰枢椎骨折,并进行术后随访及影像学评估。方法采用自行设计的一套中空穿刺器械,进行前路经皮穿刺侧块螺钉内固定同时行前部结构植骨融合术,治疗C1-2骨折38例,手术患者包括:Jeferson骨折10例,C1前弓骨折12例,寰枢椎脱位7例、半脱位5例,陈旧性齿状突骨折4例。对术后患者进行X线、CT检查,观察螺钉的位置。结果临床术后患者得到随访,平均随访2.8年,术后无严重合并症,无血管、神经损伤,无气管损伤及食管瘘,螺钉1例一侧松动,但未引起神经症状及其他合并症。1例一侧螺钉进入椎动脉孔边缘,但无椎动脉损伤。其余螺钉位置良好。结论前路经皮侧块螺钉内固定治疗C1-2操作简单,出血少,创伤小,恢复快,疗效可靠。只要采用合理的配套器械,选择正确的穿刺点及穿刺深度,该手术方法是安全可靠的。

Objective To apply the method of percutaneous anterior lateral mass fixation for instability of C11-2 vertebral fracture and determine the outcome of the method by radiology. Methods Thirty-eight cases of C1-2 instability including 10 cases of Jefferson＇ s fracture, 12 cases of anterior arch fractures of C1, 7 cases of atlantoaxial dislocation, 5 cases of atlantoaxial subdislocation, and 4 cases of dental old fracture with dislocation were treated with percutaneous anterior lateral mass screws and bone grafting with new designed hole instrumentations. All the patients were followed-up after operation and assessed the screws position by X-ray and CT. Results All cases reached a satisfactory results of fixation without injuring the vertebral artery and spinal cord. Two screws were in poor position. One screw came loose a year after operation, another screw went into the vertebral artery groove, but no vertebral artery injury. All the other screws were in good position. Conclusion The operation procedure for instability of C1.2 has the advantage of simplicity, less trauma and minimized bleeding. The operation procedure is safe with reasonable instrumentations and correct selection of the puncture point, angle and depth.