椎弓根钉棒系统固定治疗齿状突骨折合并寰枢关节不稳

Transpedicular Screw Fixation System for the Treatment of Dens Fracture Complicated with At- lantoaxial Instability

【目的】探讨椎弓根钉棒系统固定治疗创伤性枢椎齿状突骨折合并寰枢关节不稳的方法与疗效。【方法】2005年12月至2010年4月共治疗枢椎齿状突骨折合并寰枢关节不稳的成年患者26例，均为急性损伤；按Grauer改良的Anderson—D’Alonzo分型，ⅡA型5例，ⅡB型12例，ⅡC型6例，Ⅲ型3例。3例伴有脊髓损伤（IIB型2例，ⅡC型1例），均合并寰枢关节不稳。首先行颅骨牵引术力争寰枢椎复位，然后在气管插管全麻下实施颈后路寰枢椎椎弓根钉棒系统固定。其中19例行自体髂骨植骨术，7例仅行寰枢椎弓根螺钉固定。根据手术前后JOA评分评价手术疗效。【结果】本组术中未发生椎动脉或脊髓损伤，术后随访8～25个月，平均12个月。所有患者颈肩痛缓解，3例有脊髓损伤的患者均有不同程度的功能恢复；所有病例影像资料显示寰枢椎解剖关系恢复良好，螺钉位置好，术后无松动、断钉，19例植骨者6个月随访时达到骨性融合。7例未行植骨者1年半后取出内固定，寰柩关节旋转功能恢复良好。【结论】寰枢椎椎弓根螺钉固定治疗创伤性枢椎齿状突骨折合并寰枢关节不稳是一种固定牢固，安全可靠的方法。

[Objective]To explore the method and efficacy of transpedieular screw fixation system for the treatment of traumatic axial dentoid process fracture complicated with atlantoaxial instability. [Methods] Twenty six adult cases of acute axial dentoid process fracture complicated with atlantoaxial instability from Dec. 2005 to April 2010 were reviewed. Among all the cases, 18 cases were male and 8 cases were female. According to Anderson-D＇ Alonzo typing method modified by Grauer, 5 cases were type Ⅱ A, and 12 cases were type Ⅱ B, and 6 eases were type Ⅱ C, and 3 cases were type Ⅲ. Three cases were accompanied by spinal injury including 2 cases with type Ⅲ B and one case with type Ⅱ C. All cases were complicated with atlantoaxial instability. At first, all the cases underwent skull traction for atlantoaxial reduction, and then were fixed with atlantoaxial pedicle screw system by cervical posterior approach under general anesthesia. Of all cases, 19 cases underwent autologous iliac bone graft and 7 cases underwent atlantoaxial pedicle screw fixation. The surgical efficacy was assessed by JOA scores before and after operation. [Results] No vertebral artery or spinal injury occurred during operation. Mean time of follow-up was 12 months（8-25 months）. Cervicobrachialgia in all patients was alleviated. Three cases with spinal injury had the recovery of neurological function to some extent. The imaging data of all cases showed that the atlantoaxial anatomic relationship recovered well and pediele screws were in a proper position without postoperative loosening or breaking. The bony fusion was obtained in 19 cases undergoing bone graft at 6 months of follow up. The internal fixation system was removed in 7 cases without bone graft after one and a half years. Atlantoaxial rotational function was restored satisfactorily. [Conclusion]Atlantoaxial pedicle screw fixation for the treatment of traumatic axial dentoid process fracture complicated with atlanioaxial instability is a solid, safe and reliable method.