椎弓根钉棒系统治疗寰枢椎不稳与脱位的初步探讨

Application of pedicle screw-rod system to atlantoaxial instability and dislocation

目的探讨椎弓根钉棒系统治疗寰枢椎不稳与脱位的临床疗效。方法收集2007年1月至2010年9月,采用椎弓根钉棒系统治疗的18例寰枢椎不稳与脱位患者的资料,分析其手术时间、出血量及术后恢复情况。结果植入36枚寰椎椎弓根钉,35枚位置良好,1枚穿入椎管但无脊髓损伤;36枚枢椎椎弓根螺钉位置均良好。所有病例均无脊髓、神经根、椎动脉损伤。随访7～24个月,寰枢椎间植骨在5～9个月时达骨性融合,无内固定物断裂或松动,脱位无复发或加重。结论寰枢椎椎弓根钉棒系统适应证广泛,手术操作安全,临床疗效良好。术前仔细分析影像学资料,选择合适病例,术中严格操作,是成功施行本术式的关键。

Objective To explore the clinical efficacy of pedicle screw-rod system in the treatment of atlantoaxial instability and dislocation. Methods From January 2007 to September 2010, according to the data of pedicle screw-rod system applied to 18 cases with atlantoaxial instability and dislocation, the operative time, amount of bleeding and postoperative recovery were analyzed. Results All wounds healed well. Of all 36 atlantal pedicle screws,35 screws obtained satisfactory location, 1 screw mistakingly went into spinal canal. No patients had any damage of spinal cord, nerve roots and vertebral artery. After followed up for 7 - 24 months, atlantoaxial intervertebral bony fusion were found during 5 - 9 months without internal fixator fracture and fall off, recurrence or aggravation of dislocation. Conclusion Compared to Magerl screw technique, atlantoaxial pedicle screw rod system is a secure surgical technique, with extensive indications and satisfactory effect. Careful preoperative analysis of radiology imaging to exclude anatomical variation and select the appropriate cases, careful intraoperative manipulation is the key to success.