微创前路经寰枢椎关节突固定融合治疗寰枢椎不稳

MINIMALLY INVASIVE ANTERIOR TRANSARTICULAR SCREW FIXATION AND FUSION FOR ATLANTOAXIAL INSTABILITY

目的探讨微创前路经寰枢椎关节突固定融合治疗寰枢椎不稳的临床效果和并发症。方法 2007年5月-2010年12月,对13例寰枢椎不稳患者行前路经皮关节突螺钉固定和内镜下植骨。其中男11例,女2例;年龄17～61岁,平均41.3岁。受伤至手术时间5～14 d,平均7.4 d。合并横韧带断裂Jefferson骨折6例,齿状突骨折5例,游离齿状突2例。术前Frankel分级为D级2例,E级11例。记录手术时间、术中出血量、放射线暴露时间和并发症,术后X线片观察寰枢椎稳定性,末次随访时评价神经功能恢复情况,并行薄层CT扫描三维重建评价融合情况。结果手术时间95～156 min,平均124 min;术中出血量30～105 mL,平均65 mL;放射线暴露时间30～64 s,平均41 s。13例均获随访,随访时间12～47个月,平均25.9个月。无血管、脊髓神经、气管、食道损伤及内植物失败等并发症。植骨融合时间6个月,动力位X线片未见不稳。末次随访时Frankel分级均为E级。寰枢椎融合率为84.6%(11/13);2例关节间隙未见连续性骨桥形成,但寰枢椎稳定。结论微创前路经寰枢椎关节突固定融合是治疗寰枢椎不稳的一种安全有效方法,具有微创技术优点。

Objective To investigate the clinical results and complications of minimally invasive anterior transarticular screw fixation and fusion for atlantoaxial instability. Methods Between May 2007 and December 2010, 13 patients with atlantoaxial instability were treated with minimally invasive anterior transarticular screw fixation and fusion under endoscope. There were 11 males and 2 females, aged 17-61 years （mean, 41.3 years）. The time between injury and operation was 5-14 days （mean, 7.4 days）. All cases included 6 patients with Jefferson fracture, 5 with odontoid fracture, and 2 with os odontoideum. According to Frankel classification of nerve functions, 2 cases were rated as grade D and 11 cases as graed E. The operation time, intra-operative blood loss, radiation exposure time, and complications were recorded and analyzed. The stability was observed by X-ray films. The clinical outcome was assessed using the Frankel scale, and the fusion rates were determined by CT scan three- dimensional reconstruction at last follow-up. Results The mean operation time was 124 minutes （range, 95-156 minutes）; the mean intra-operative blood loss was 65 mL （range, 30-105 mL）; and the mean radiation exposure time was 41 seconds （range, 30-64 seconds）. Thirteen patients were followed up 12-47 months （mean, 25.9 months）. No blood vessel and nerve injuries or internal fixator failure occurred. The bone fusion time was 6 months, and the dynamic cervical radiography showed no instability occured. At last follow-up, the neurological function was grade E in all patients. The fusion rate was 84.6% （11/13）. No continuous bone bridge was seen in the joint space of 2 patients, but they achieved stability. Conclusion Minimally invasive anterior transarticular screw fixation and fusion is a safe and effective procedure for treatment of atlantoaxial instability.