上颈椎手术的内固定应用

The Application of Internal Fixation for the Operation on Upper Cervical

回顾102例上颈椎不稳的治疗,进一步分析各种上颈椎内固定技术的要点和适应症。方法:102例患者中,寰椎骨折2例行颈枕固定融合。齿状突骨折齿状突螺钉固定11例,行寰枢椎椎弓根螺钉2例。Hangman骨折行枢椎椎弓根螺钉固定18例,前路钢板固定11例,寰枢椎钢丝固定1例。寰枢椎脱位不稳行寰枢椎钢丝固定10例,寰枢椎椎弓根螺钉22例,颈枕固定融合18例。C2-3脱位行C2-3椎弓根螺钉2例,前路钢板固定3例。C2椎体肿瘤1例前后联合固定。先天性颈椎后突1例行前路钛网加钛板固定。所有患者术后颈围领保护3月。结果:102例患者经治疗上颈椎获得满意的稳定性,优良率达94.9﹪。结论:在上颈椎手术时,内固定技术的选择要根据具体条件和技术水平来决定,同时要严格掌握手术适应症。

We reviewed the operations for 102 cases of upper cervical instability,analyzed the key and indication of various kinds internal fixation technical of upper cervical. Methods：In 102 cases,atlas fracture：2 cases by cerv-pillow fixation. Odontoid fracture：ll cases by odontoid screw fixation,2 cases by atlantoaxial pedicle screw fixation. Hangman＇ fracture： 18 cases by axis pedicle pedicle screw fixation, l lcases by plate fixation, 1 cases by atlantoaxial wire lock. Atlantoaxial instability： 10 cases bv atlantoaxial wire lock,22 cases by atlantoaxial pedicle screw fixation, 18 cases by cerv-pillow fixation. C2-3 dislocation：2 cases by pedicle screw fixation,3 case by plate fixation.1 case with C2 tumor by AP affiliation fixation.1 case with congenital cervical processus aboralis by anterior plate fixation.All cases were protected by neck collar for 3 months after operation. Results 102 cases got satisfactory stability after curatio. Conclusion The election of internal fixation technical is decided by technical level,also it is important to handle the operation indication.