寰椎侧块枢椎椎弓根螺钉加钛缆内固定治疗寰枢椎脱位3例

Inner Fixation with Lateral Mass Epistropheus Pedicle Screws plus Titanium Cable for Treatment of Atlantoaxial Dislocation

目的探讨后路寰椎侧块枢椎椎弓根螺钉加钛缆内固定治疗寰枢椎脱位的可行性和疗效。方法采用后路寰椎侧块枢椎椎弓根螺钉加钛缆内固定治疗寰枢椎脱位3例,其中3例均为男性,年龄2856岁,车祸伤2例,砸伤1例,齿状突骨折1例,寰枢关节脱位2例。按Dickman等根据横韧带及骨性结构的损伤程度及范围分型：ⅠA型2例,ⅡB型1例。观察后路寰椎侧块枢椎椎弓根螺钉加钛缆内固定治疗寰枢椎脱位的力学稳定性和植骨融合情况。结果术后随访6个月-2年,平均16个月。术后3个月随访,植骨均得到骨性愈合,与术前X线相比,侧块椎弓根螺钉及固定钛缆无断裂、松动及脱落征象。结论后路寰椎侧块枢椎椎弓根螺钉加钛缆内固定治疗寰枢椎脱位即提供了坚强的内固定,减少了钛缆断裂等并发症,又给了植骨块一个很好的固定,更好的促进了植骨融合,提高了疗效。

Objective To Investigate the feasibility and curative effect of inner fixation with lateral mass epistropheus pedicle screws plus titanium cable for treatment of atlantoaxial dislocation.Methods Inner fixation with lateral mass epistropheus pedicle screws plus titanium cable was applied to atlantoaxial dislocation in three males（aged from 28 to 56）,among whom two were injured from traffic accident and one was injured by smash（odontoid fracture in one,atlantoaxial dislocation in two）.By damnification degree and range of the ligament and bony structure（Dickman＇s classification）,two were diagnosed as type IA and one was diagnosed as type IIB.Mechanical stability and bonefusion status were investigated after inner fixation with lateral mass epistropheus pedicle screws plus titanium cable.The follow-up duration was from 6 months to 2 years,with an average of 16 months.Results Three months after treatment,all the bones fused well.According to the comparison with preoperative X-ray findings,there were no signs of rupture,loosing or falling in the lateral mass pedicle screws and the fixing titanium cables.Conclusion The method of using lateral mass epistropheus pedicle screws plus titanium cable offers a strong inner fixation for tratement of atlantoaxial dislocation,reduces syndrome like titanium cable rupture and gives a nice fixation for bone,which accelerates the bone fusion and improves the curative effect.