寰枢椎椎弓根钉治疗寰枢椎脱位的临床应用

Clinical application of atlantoaxial pedicle screw internal fixation for treatment of atlantoaxial dislocation

目的:探讨经后路寰枢椎椎弓根钉固定系统复位固定植骨融合治疗寰枢椎脱位的临床疗效。方法:2005年12月至2007年6月收治16例寰枢椎脱位的患者,男10例,女6例;年龄38～45岁,平均40.5岁;其中12例伴有神经损伤,按ASIA分级:B级3例,C级5例,D级4例。术前均行寰枢椎CT扫描及X线检查,入院后立即行颅骨牵引。术中应用经后路通用脊柱椎弓根钉棒矫形固定系统固定,同时在寰椎后弓和枢椎椎板间大量髂骨植骨融合。观察术后近期疗效及并发症情况。结果:术中未发生血管、神经等重要组织结构的损伤。16例患者均获得随访,随访时间12～24个月,平均18个月。术后所有患者头枕部疼痛、酸困不适症状均得到改善,采用Odom临床疗效评定标准,优12例,良4例。12例伴有神经损伤患者11例得到明显恢复。按ASIA分级:B级1例,C级2例,D级5例,E级4例。无内固定物松动及断裂,所有植骨均达骨性融合。结论:经后路寰枢椎椎弓根钉固定系统复位固定植骨融合能够直视下置钉、短节段固定、术中复位,且固定可靠,融合率高,有利于上颈椎稳定性重建及脊髓神经功能恢复。

Objective：To investigate the clinical effect of atlantoaxial pedicle screw internal fixation for treatment of atlantoaxial dislocation. Methods：Sixteen patients with atlantoaxial dislocation were treated from Dec. 2005 to June. 2007,included 10 males and 6 females,aged from 38 to 45 years old（means 40.5 years）. Among them 12 patients combined with nerve injury,according to ASIA grade：there were 3 cases in grade B,5 cases in grade C,4 cases in grade D. All patients received preoperative CT,radiograph and skull traction. Intraoperative posterior approach general spine pedicle screw rod orthopaedics fixation system used and iliac bone block were implanted in space of posterior atlantal arch and axial vertebral plate. The outcome and complications were observed in the near future. Results：There was no vascular or neural injury found. The patients were followed up for 12 to 24 months （means 18 months）. All head pain,acid storm symptoms were improved after operation. According to the Odom＇s clinical efficacy evaluation standard,12 cases were excellent,4 were good. Eleven cases of 12 with nerve injury recovered significantly. By ASIA classification：1 cases was in grade B,2 cases were in grade C,5 cases were in grade D,4 cases were in grade E. No looseness or breakage of screw occurred. Bony fusion was achieved in all cases. Conclusion：Posterior approach atlantoaxial pedicle screw internal fixation have the advantages of direct screw placement,short segment fusion,intraoperative reduction,fixation reliable,high fusion rate,and it can restablish the upper cervical vertebrae stability and help to recover the spinal cord and nerve function.