寰枢椎脱位后路螺钉固定方法的临床选择

The Clinical choice of C1 and C2 posterior screw fixation methods for atlantoaxial dislocation

目的探讨寰枢椎脱位后路钉棒固定术中寰椎螺钉和枢椎螺钉固定方法的临床选择。方法对2002年11月至2011年12月广州军区广州总医院收治的228例可复性和23例难复性寰枢椎脱位患者,术前进行置钉可行性和复位可能性评估,针对性地选择寰椎和枢椎的后路螺钉固定方法,进行寰枢椎后路钉棒固定治疗。结果 251例患者均行钉棒固定并获得满意复位。寰椎螺钉固定采用椎弓根螺钉403枚、部分经椎弓根螺钉77枚、侧块螺钉22枚;枢椎螺钉固定采用椎弓根螺钉437枚、椎板螺钉56枚、侧块螺钉9枚。术中未发生椎动脉、脊髓损伤。237例患者获得随访,随访时间4～38个月,平均随访时间13个月。230例患者获骨性融合;6例为纤维愈合,动力位片(均随访2年以上)未见复发脱位;另1例为假关节未融合并双侧枢椎椎弓根螺钉松动,行后路翻修手术治愈。结论根据寰枢椎脱位的复位难易程度和个体解剖特点灵活选择寰椎和枢椎不同的后路螺钉固定方法,扩大了寰枢椎后路钉棒固定技术的适用范围,提高了手术安全性和成功率。

Objective To explore the clinical choice Of the C1 and C2 screw fixation methods of posterior C1-C2 screw-rod technique in atlantoaxial dislocation treatment. Methods From November 2002 to December 2011, 228 reducible and 23 irreducible atlantoaxial dislocation patients treated in Guangzhou General Hospital of Guangzhou Military Command underwent posterior C1-C2 screw-rod fixation. The feasibility of the screw placement and the possibility of the alignment reduction were evaluated preoperatively, and the individual selected posterior screw fixation methods of C1 and C2 were adopted. Results All 251 cases had C1-C2 screw-rods fixation and obtained satisfactory reduction. There were total 502 C1 screws placed including 403 pedicle screws, 77 partial transpedicular screws and 22 lateral mass screws; and 502 C2 screws placed including 437 pedicle screws, 56 translaminar screws and 9 lateral mass screws. No neural or vascular injury was observed. In this group, 237 cases were followed up from 4 to 38 months （averaged 13 months）, and 230 patients had a solid bone fusion, 6 cases had a fibrous union but no dislocation reoccurred on dynamic lateral cervical spine radiographs after more than 2 years＇ follow-up, only one case was found pseudoarthrosis with bilateral C2 pedicle screw loosen and then cured after a posterior revision operation. Conclusion For atlantoaxial dislocation patients, the selection of C1 and C2 screws fixation methods should be in accordance with the individual anatomy and reduction difficultness, so as to expand the adaptability of the screw-rod fixation technique, to enhance the clinical achievement, and to improve the safety of the surgery.