椎弓根螺钉技术治疗难复性寰枢椎脱位的疗效分析

Efficacy of pedicle screw instrument for treatment of irreducible atlantoaxial dislocation

[目的]评估椎弓根螺钉技术治疗难复性寰枢关节脱位的手术可操作性和疗效,并选择一种有效的内固定方法治疗寰枢椎脱位。[方法]2003年6月-2009年2月,行一期经口咽入路寰枢关节前路松解,后路采用寰枢椎椎弓根螺钉技术治疗寰枢椎脱位并高位脊髓压迫症14例。术前均行X线片、CT、MRI等影像学检查;术中在直视下行C1、2置钉,复位固定,椎板后弓植骨。术后除枕颈融合需颈托固定3个月外,其它无需外固定。[结果]所有螺钉均成功置入,复位固定满意。14例病人均获得了平均18个月的随访,均达到了骨性愈合。没有神经、血管损伤,未发现螺钉松动、断钉和寰枢椎再移位病例。12例患者脊髓功能明显改善,2例好转。[结论]经寰枢椎椎弓根螺钉内固定技术具有直视下置钉、短节段固定、术中复位满意、融合率高等特点,为寰枢椎脱位患者治疗提供了一种较好的内固定术式。

[Objective]To explore the surgical feasibility and clinical outcome of pedicle screw instrument for treatment of irreducible atlantoaxial dislocation and to choose an effective method of internal fixation.[Method]From June 2003 to February 2009,14 pationts with atlas dislocation followed by upper cervical cord compression were treated surgically with oral anterior soft tissue release combined with posterior reduction and pedicle screw instrument.Preoperative CT,MRI and radiographs as well as intraoperative screw placement and bone graft were administered in all pationts.Only cervical collars were used as external support for 3 months in occipitocervical fusion.[Result]All screws were successfully placed in atlas and axis.Forteen patients were followed up for an average of 18 months.Bone fusion was achieved in all cases with no complications of nerve,internal fixation failure and redislocation.Neurological recovery was significantly improved in 12 cases and took a turn for better in 2 cases.[Conclusion]Pedicle screw instrument in atlas and axis has the advantages of direct screw placement,short-segment fusion,intraoperative reduction and high fusion rate.It is a better alternative for atlantoaxial dislocation.