寰枢椎椎弓根钉内固定治疗寰枢椎不稳

Treatment of atlantoaxial instability with C_(1、2) pedicle screw fixation

目的探讨寰枢椎椎弓根钉内固定治疗寰枢椎不稳的方法与临床疗效。方法自2007年12月-2010年6月采用寰枢椎椎弓根钉内固定治疗C1,2不稳21例，其中AndersonII型齿状突骨折14例（陈旧性骨折11例，新鲜骨折3例），Ⅲ型陈旧性齿状突骨折1例，先天性游离齿状突并寰枢椎不稳6例。结果21例共置入螺钉82枚。其中有1例6岁儿童在寰椎后弓上2个挂钩。随访时间12-40个月，平均27个月，术后JOA评分14—17分。平均14．8分。无感染，未发生与螺钉相关的神经血管并发症，无内固定松动或断钉现象，21例植骨者术后随访均已达到骨性融合。结论寰枢椎椎弓根钉内固定技术是治疗寰枢椎不稳的有效方法；难复性脱位患者先行前路松解术再经后路手术可获得良好的复位与融合：小儿亦可行该术式。

Objective To explore the clinical outcomes of transpedicular instrumentation for the treatment of atlantoaxial instability. Methods From December 2007 to June 2010,21 cases of atlantoaxial instability undergoing the transpedicular fixation were reviewed.There were 14 cases type II odontoid fracture （11 cases of old odontoid fracture,3 cases fresh odontoid fracture）, 1 case type III old odontoid fracture,6 cases congenital loose odantoid process.Results A total of 82 screws were inserted safely.One case of a 6 years old child was operated with 2 hooks on atlas.Mean time of follow-up was 27 months （range from 12 to 40 months）. The postoperative JOA scores were from 14 to 17,with an average of 14.8. The clinical and ra- diolagic fonow-up data indicated solid fusion in all the patients.The postoperative radiographs verified all of atlas screws with a good position. Conclusion The transpedicular frxation is an effective method for the treatment of atlantoaxial instability. Transeral release and then posterior reduction by pedicle screw instrumentation for the treatment of ireducible atlantoaxial dislocation is good reduction and fusion. Children were also feasible the surgery.