经后路钉板固定植骨融合治疗环枢椎不稳

Effect of atlantoaxial screw-plate fixation and bone graft fusion on atlantoaxial instability

目的探讨经后路环枢椎钉板固定融合治疗环枢椎不稳的临床疗效。方法2005年6月至2010年6月采用后路环枢椎侧块钉板固定颗粒状自体松质骨植骨融合治疗环枢椎不稳12例，其中齿状突陈旧性骨折6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，影像学显示环枢椎不稳，术前JOA评分6-11分，平均7．4分。结果所有患者均获随访，随访时间10—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8例，略有改善3例，无变化1例；术后JOA评分13。17分，平均15．6分。结论环枢椎钉板内固定颗粒状自体松质骨植骨，可保障环枢椎稳定，促进环枢关节融合，是治疗环枢椎不稳的有效方法。

Objective To investigate the clinical effect of atlantoaxial screw-plate fixation and bone graft fusion on atlantoaxial instability. Methods From June 2005 to June 2010, 12 patients with atlantoaxial instability were treated with atlantoaxial lateral mass screw-plate fixation and self-cancellous bone graft fusion. There were 8 males and 4 females, with a mean age of 38.5 years（range,21-70 years）. Six cases were old odontoid fracture, 6 cases with odontoid developmental deformity. All patients had symptoms and signs of upper cervical myelopathy, imaging displayed atlantoaxial instability. JOA scores in preoperation were from 6 to 11, with an average of 7.4. Results All patients got followed up, the mean time of follow-up was 28 months （range, from 10 to 40 months）. The follow-up data indicated solid fusion in all patients, posterior reduction were satisfactory, no loosening or screw-plate broken were found. There were 8 cases with spinal cord function improved obviously, 3 cases improved slightly, 1 case with no changed, the postoperative JOA scores were from 13 to 17, with an average of 15.6. Conclusions Atlantoaxial screw-plate fixation and self-cancellous bone graft, can stabilize atlas and axis, and be easier for atlanto-axial infusion, it is an effective method in the treatment of atlantoaxial in-stability.