经后路寰枢椎椎弓根钉棒内固定治疗寰枢椎不稳

Internal Fixation with Pedicle Screw-rods for Atlantoaxial Instability

目的探讨经后路寰枢椎椎弓根钉棒内固定治疗寰枢椎不稳的临床疗效。方法2007年1月～2010年3月采用寰枢椎经后路椎弓根钉棒内固定治疗C1-2不稳患者26例，男17例，女9例，年龄18～72岁，平均45．5岁。皆有寰枢椎脱位或半脱位，其中先天性齿状突不连_1l例，陈旧齿状突骨折6例，新鲜齿状突骨折（ⅡC型）3例，寰椎横韧带断裂4例，寰椎骨折2例。术前JOA评分（8．6±3．0）分。结果26例手术时间2．5～3．5h，平均2。9h；出血量400～650ml，平均460ml。术中未发生椎动脉和脊髓损伤。所有患者均获随访，随访时间6～33个月，平均随访17．5个月，术后3个月JOA评分（14．7±2．1）分。螺钉位置良好，无钉棒断裂、变形及松动，3～6个月21例植骨患者均获植骨融合。5例未行植骨患者1年后拆除内固定，寰枢关节旋转功能良好。结论寰枢椎椎弓根钉棒固定术是治疗寰枢椎不稳的有效方法。

Objective To observe the clinical effect of atlantoaxial pedicle screw-rods system fixation and fusion for the treatment of upper cervical diseases. Methods From January 2007 to March 2010,26 patients with upper cervical diseases were treated with atlantoaxi- al pedicle screw-rods system fixation and fusion. There were 17 males and 9 females（ 18 -72 years）. Of 26 cases, they were all atlantoaxial dislocation,including 11 cases of congenital odontoid disconnection ,6 cases of old odontoid fracture,3 cases of new odontoid fracture（type Ⅱ C ） ,4 cases of rupture of the transverse ligament, and 2 cases of atlas fracture. JOA score before operation was 8.6 ± 3.0. Results The mean operative time and bleeding amount were 2.9 hours（ 2.5 - 3.5 hour） and 460ml （400 - 650ml） respectively. No injuries to the vertebral artery and spinal cord were observed. Mean time of follow-up was 17.5 months（ range from 6 to 33 months）. JOA score after operation was 14. 7 _＋ 2.1. The clinical symptoms were improved to some extents and the screws were verified to be in a proper position, no breakage or loose- ning of screw and rob occurred. The clinical and radiologic follow-up data indicated solid fusion in 21 patients. Internal fixation system was removed one ）,ear after opration in 5 cases who were not received bone graft fusion and atlantoaxial rotational function was restored satisfactorily. Conclusion The atlantoaxial pedicle screw-rods system fixation and fusion are feasible for the treatment of upper cervical diseases.