后路寰枢椎固定融合治疗陈旧性寰枢椎损伤

Posterior atlantoaxial fusion fixation for old atlantoaxial injury

目的探讨后路寰枢椎固定融合治疗陈旧性寰枢椎损伤继发寰枢椎脱位的临床疗效。方法回顾性分析2008年3月一2012年3月采用寰枢椎后路固定融合术治疗的陈旧性寰枢椎损伤继发寰枢椎脱位患者16例，其中男14例，女2例。受伤至手术时间3～36个月，平均10．5个月。其中采用寰枢椎后路椎弓根钉板系统治疗13例，包括陈旧性齿状突骨折10例，陈旧性创伤性寰椎横韧带断裂合并寰枢椎脱位3例。采用经寰椎后弓椎弓根钉板联合枢椎椎板螺钉固定治疗3例，均为陈旧性齿突骨折合并寰枢关节脱位。全部患者在复位固定的同时行椎板间自体骨植骨。比较术前、术后日本骨科学会（JOA）评分变化，术后随访x线片及CT，观察寰枢椎复位及融合情况。结果所有患者均获随访，随访时间9～18个月，平均13个月。全组患者无一例发生脊髓或椎动脉损伤。复查cT显示2例一侧枢椎柞弓根螺钉部分进入横突孑L，但无神经或血管损伤并发症，临床症状得到不同程度改善。术后JOA评分13～16分，平均14．8分，术前、术后JOA评分改善率为71％～92％，平均82％。复查x线片、cT显示骨性融合好，未见寰枢椎失稳或复位丢失征象，固定螺钉位置良好，无松动或断钉发生。结论后路寰枢椎固定融合可有效重建寰枢椎稳定性，并能改善脊髓神经功能，疗效可靠。

Objective To investigate the clinical effects of posterior atlantoaxial fusion fixation in treatment of old atlantoaxial injury secondary to atlantoaxial dislocation. Methods A retrospective a- nalysis was carried out on 16 patients （ 14 males and 2 females） with old atlantoaxial injuries secondary to atlantoaxial dislocations managed with posterior atlantoaxial fusion fixation from March 2008 to March 2012. The time from injury to operation lasted for 3-36 months （ average 10.5 months）. Posterior atlantoaxial transpedicular fixation was performed in 13 patients including 10 patients with old odontoid fractures and three with old traumatic transverse ligament disruptions of the atlas combined with atlantoaxial disloca- tions. Also, posterior atlantal arch transpedielar fixation combined with axial pedicle screw fixation was performed in three patients who had old odontoid fractures combined with atlantoaxial dislocations. All pa- tients had simultaneous autogenous bone grafting between atlas and axis during reduction and fixation. The preoperative and postoperative Japanese Orthopaedic Association （JOA） scores were compared. Follow-up X-ray films and CT was performed to evaluate the atlantoaxial reduction and fusion. Results All the patients were followed up for 9-18 months （ mean 13 months）. None of the patients had spinal cord or vertebral artery injuries. Follow-up CT showed that two patients had partial penetration of one side axial pediele screws into transverse foramen without nerve and blood vessel injuries. Clinical symptoms obtained different degree of improvement. The postoperative JOA scores ranged from 13 to 16 points （mean 14.8 points） and the improvement rate of JOA was 71%-92% （mean 82% ）. The X-ray films and CT showed sound bone fusion,with good location of screws but with no signs of atlantoaxial instability or loss of reduction, or loosening or breakage of the screws. Conclusion Posterior atlantoaxial fusion fixation can effectively reconstruct atlantoaxial stability, improves neurologic function of spinal cord and has relia- ble curative effects.