寰枢椎椎弓根钉棒系统内固定融合术治疗上颈椎损伤

Application of atlantoaxial pedicle screw system in the treatment of upper cervical injury

目的探讨经后路寰枢椎椎弓根钉棒系统内固定融合术治疗上颈椎损伤的可行性、方法、疗效和适应证。方法对13例上颈椎损伤患者行后路寰枢椎椎弓根钉棒系统内固定融合术。其中陈旧性齿状突骨折不愈合4例，新鲜齿状突骨折（Aderson Ⅱ C型）2例，寰椎横韧带断裂3例，寰椎骨折4例。13例均采用美国强生Depuy公司生产的后路Summit钉棒系统和山东威高公司生产的PCF钉棒系统行后路寰枢椎椎弓根内固定（万向螺钉直径3．5mm，寰椎螺钉长26～30mm，平均28mm，枢椎螺钉长24～28mm，平均26mm），术后不用外固定或用颈领保护1～3个月。结果13例共置入寰椎椎弓根螺钉26枚，枢椎椎弓根螺钉26枚。平均手术时间2．6h，平均出血量470ml。术中未发生椎动脉和脊髓损伤。全组患者获得4～25个月（平均13个月）随访。临床症状得到不同程度的改善，有神经损伤患者日本骨科协会（JOA）评分改善率为72％～91％，平均81％。X线、CT复查示螺钉位置良好，无钉棒断裂、变形、松动，1枚寰椎螺钉前端穿透侧块内上皮质约3mm，但未影响寰枕关节活动，其余位置满意。3—6个月后所有患者均获植骨融合。1例寰椎骨折患者出现寰枕腹侧融合。结论经后路寰枢椎椎弓根钉棒系统内固定融合术治疗上颈椎损伤具有可行性，如果操作方法得当，疗效较好，适应证较广，应用前景广阔。

Objective To investigate the methods, feasibility, outcome and indications of atlantoaxial pedicle screw system in the treatment of upper cervical injury. Methods Thirteen patients with upper cervical injury were treated by atlantoaxial pedicle screw system. There were four patients with old odontoid fractures, two with new odontoid fractures （ Aderson ⅡC ） , three with rupture of the transverse ligament of C1 and four with C1 fracture. Results A total of 26 pediele screws and 26 pediele screws were implanted. The mean operation time and perioperative blood loss were 2.6 hours and 470 ml, respectively. No injury to the vcrtebral artery and spinal cord was observed. All patients were followed up for 4-25 months （mean 13 months）. The clinical symptoms were improved to some extent according to Japanese Orthopedic Association scoring system, with improvement rate of 72%-91% （mean 81% ）. The screws were verified to be fixed in a proper position, and no hardware broken or loosening was observed except for one C1 screw penetrating the medial superior cortex of lateral mass for 3 mm without affecting occipito-atlantal motions. All patients had a solid bony fusion 3-6 months later. Conclusion The atlantoaxial pedicle screw system is feasible in the treatment of upper cervical injury with the advantages of better outcomes and wider indications.