寰枢椎钉板固定融合治疗寰枢椎不稳

Atlanto axial screw plate fixation and bone fusion for the treatment of atlanto axial instability

目的:探讨经后路寰枢椎钉板固定融合治疗寰枢椎不稳的临床疗效。方法:2003年6月至2008年6月,采用后路寰枢椎侧块钉板固定颗粒状自体松质骨植骨融合治疗寰枢椎不稳15例,男10例,女5例,年龄19～72岁,平均41.7岁。其中齿状突陈旧性骨折6例,类风湿性关节炎3例,齿状突发育畸形6例。患者均有不同程度的高位颈脊髓病症状体征,影像学显示寰枢椎不稳,术前JOA评分6～11分,平均7.4分。结果:所有患者均获得随访,时间9～40个月,平均28个月。所有植骨达到骨性融合,复位无丢失,未发现内固定松动断裂。脊髓功能明显改善者10例,略有改善者4例,无变化者1例;术后JOA评分13～17分,平均15.6分。结论:寰枢椎钉板内固定颗粒状自体松质骨植骨,可保障寰枢椎稳定,促进寰枢关节融合,是治疗寰枢椎不稳的有效方法。

Objective：To explore the clinical outcomes of atlanto axial screw plate fixation and bone fusion for the treatment of atlanto axial instability. Methods：From June 2003 to June 2008,15 cases with atlanto axial instability were treated with atlanto axial lateral mass screw plate fixation and self cancellous bone graft fusion. There were 10 males and 5 females with the mean age of 41.7 years （range,from 19 to 72 years）. Six cases were old odontoid fracture,3 cases rheumatoid arthritis, 6 cases odontoid developmental deformity. All patients had symptoms and signs of upper cervical myelopathy and the imaging displayed atlanto axial instability. JOA scores before operation were from 6 to 11 with an average of 7.4. Results：All patients were followed up with the mean of 28 months （range,from 9 to 40 months）. The follow up data indicated solid fusion in all patients,posterior reductions were satisfactory,no loosening or screw plate broken was found. There were 10 cases which spinal cord function improved obviously,4 cases improved slightly,1 case no changed in the study. The postoperative JOA scores were from 13 to 17 with an average of 15.6. Conclusion：Atlanto axial screw plate fixation and self cancellous bone graft can stabilize atlas and axis,and promote fusion of atlanto axial joint,which is an effective method for the treatment of atlanto axial instability.