后路经关节螺钉内固定治疗寰枢椎不稳定的疗效评价

Evaluation of the efficacy for posterior articular screw fixation in patients with atlantoaxial instability

目的：评价后路经关节螺钉内固定治疗寰枢椎不稳的临床价值。方法：对2005年1月至2009年6月入我院的寰枢椎不稳定43例患者采用后路经关节螺钉内固定治疗,术后进行系统随访,复查影像学及进行日本矫形外科协会颈椎功能评分（Japanese orthopedic association,JOA）及视觉模拟疼痛量表（Visual analogue scale,VAS）评分。结果：共置入枢椎椎弓根螺钉43枚,术中无并发症发生。术后X线片示寰枢椎获解剖复位39例,旋转脱位大部分矫正4例,所有内固定位置良好。脊髓受压者复查MRI显示脊髓形态恢复正常。术后2-3个月获得寰枢椎骨性融合。术后6月时,患者的颈椎功能（t=14.099,P=0.000）和疼痛情况（t=19.335,P=0.000）较术前有明显改善,患者的颈椎功能平均改善率为86.1%±5.2%。结论：后路经关节螺钉内固定术治疗寰枢椎不稳定,疗效可靠、并发症少,可作为其有效的常规术式。

Objective：To evaluate the clinical value of posterior articular screwfixation in patients with atlantoaxial instability.Methods：From January 2005 to June 2009,43 patients in our hospital with atlantoaxial instability were treated by posterior screw fixation.The clinical values were accessed by radiographic imaging,JOA and VAS score in 5 years follow-up.Results：No intraoperative complication occurred in 43 patients.Postoperative X-ray film showed anatomical reduction in 39 patients,correction of most of dislocation in 4 patients,all the internal fixation were in good position.Spinal MRI showed spinal cord compression were back to normal.After 2 to 3 months,atlanto-axial were vertebraed.After 6 months,the patient＇s cervical spine function（t=14.099,P=0.000）and pain conditions（t =19.335,P=0.000）were significantly improved compared with before surgery,the average improvement rate was 86.1%±5.2%.Conclusion：The posterior screw fixation in the treatment of atlantoaxial instability is effective and reliable,have less complications and can be used as an effective surgical procedure.