前路经寰枢关节螺钉内固定术治疗寰枢关节不稳定的解剖学及临床研究

The anatomical and clinical study on anterior C1-C2 transarticular screw fixation for the treatment of traumatic instability of C1-2 joint

目的为前路经寰枢关节螺钉内固定术提供临床解剖学依据。方法在100对中国成人干燥寰、枢椎配对标本上，对与临床前路经寰枢关节螺钉内固定术相关的数据进行解剖学测量。并对11例创伤性寰枢椎不稳定患者施行了前路经寰枢关节螺钉内固定术，在齿状突与寰椎前结节后方置入颗粒状松质骨。结果前路经寰枢关节螺钉内固定术冠状面上螺钉植入最小外偏角（5．5±2．0）度，最大外偏角（23．6±2．1）度，矢状面上螺钉植入最小后倾角（14．9±2．6）度，最大后倾角（25．6±2．5）度，内侧钉道距离（16．58±1．49）mm，外侧钉道距离（26．44±1．75）mm。11例患者中，1例颈脊髓完全损伤患者，术后1个月死于肺部感染。其余10例病例获得随访，时间7个月～3年，平均17个月，无椎动脉及脊髓损伤，所有病例获得骨性融合。结论前路经寰枢关节螺钉内固定术，操作简便，损伤脊髓或椎动脉的风险较小，为寰枢椎不稳定患者提供了一种新的内固定治疗方法。

Objective To provide anatomic data for anterior C1-C2 transarticular screw fixation and clarify its curative effect in curing the patients with C1 -C2 instability. Methods Direct measurements were taken from 100 pairs of dried Chinese human C1 and C2 vertebrae and 11 patients who had C1-C2 traumatic instability were operated on with anterior C1-C2 transarticular screw fixation technique. Results In the anterior C1-C2 transarticular screw placement,the lateral angulation of the screw placement relative to sagittal plane ranged from （5.5 ± 2.0） ° to （ 23.6 ± 2.1 ） ° on average. The posterior angulation relative to the coronal plane ranged from （ 14.9 ± 2.6 ） ° to （ 25.6 ± 2.5 ） °. The length of the medial screw path ranged from （ 16.58± 1.49） to （26.44 ± 1.75 ） mm. In the 11 patients, one patient with cervical cord trauma was died of pulmonary infection one month later, and the remaining 10 patients were followed up for about 7 months to 3 years （mean 17 months）. They all had no trauma on vertebral artery and cervical cord during their cervical operations. All these cases had atlantoaxial synostoses. Conclusion The anterior C1-C2 transarticular screw fixation was not only manipulated easily,but also had a less risk of inju- ring vertebral artery and cervical cord. It provides a new treatment of internal fixation for the patients with atlantoaxial instability.