经关节螺钉内固定治疗寰枢椎不稳

Transarticular screw fixation for the treatment of atlantoaxial instability

目的探讨经关节螺钉内固定治疗寰楸椎不稳的疗效，方法自2000年5月至2011年10月使用经关节螺钉内固定治疗寰枢惟不稳患者56例，男43例，女13例；年龄17～71岁，平均38岁。1例患行脊髓神经完全损伤，29例无脊髓神经损伤症状，26例伴有脊髓神经小全损伤，按关幽脊髓损伤协会（ASIA）脊髓神经功能障碍分级：C级10例，D级16例；ASIA评分50～90分，平均（78．5±9．3）分。其中后路经关节螺钉内固定32例，在寰椎后弓与枢椎椎板表向植骨。前路经关节螺钉内固定24例，在寰椎前弓下缘和齿状突基底部之间植骨。结果1例颈脊髓神经完全损伤患者前路经寰枢关节螺钉内固定，术后1个月死于肺部感染。其他55例患者术后获6个月至9年（平均16个月）随访，手术切口均I期愈合。1例齿状突Ⅱ型粉碎性骨折并寰枢关节脱位患者寰枢椎前路经关节螺钉内固定并植骨，齿状突未骨性愈合，但寰枢关节纤维连接无不稳定表现。其余植骨患者均获骨性融合。26例脊髓神经不全损伤患者术后ASIA分级（C级3例，D绒10例，E级13例）和评分[（92．5±8．6）分]均较术前明显改善，差异有统计学意义（P〈0．05）。结论寰楸椎经关节螺钉内固定，操作简便、费用低廉、疗效可靠，可以作为治疗寰枢椎不稳患者的有效手段。

Objective To evaluate transartieular screw fixation in the treatment of atlantoaxial instability. Methods From May 2000 Io October 2011, 56 patienls with atlantoaxial instability were trealed with transartieular screw fixation in our del）artmenh They were 43 men and 13 women, aged from 17 to 71 vears （average, 38 years） . One patient had complete trauraa at the cervical cord, 29 patients presented with no symptom of detects of the cervical eord, and 26 patients were complicated with partial injury to the cervical eord. Of the 26 patients with incomplete neural injury, 10 were rated as grade C and 16 as grade D according to the American Spinal hi jury Assoeiation （ASIA） grading system. Their ASIA scores ranged from 50 to 90 points, averaging 78.5 -9.3 points. For 24 patients, anterior C1-2 transartieular screw fixation was conducted together with bone grafting between the lower edge of the anterior areh of atlas and odontoid base. For another 32 patients, posterior C 1-2 transartiealar serew fixation was conductted together with bone grafting between the posterior arch of atlas and the surface of axis lamina. Results One patient with complete trauma at the cervical cord died of puhnonal7 infection one month after anterior C1-2 transartieular screw fixation. Other 55 palients were followed up from 6 months to 9 years, averaging 16 months. All surgical incisions got primary healing. One patient with comminttted odontoid II fraeture and atlantoaxial dislocation failed to achieve bony anion after anterior CI-2 transartieular screw fixation and bone grafting, but still obtained stability of atlantoaxial joint. The other eases all had bone fusion after bone grafting. The 26 patients with inconlplete neural injury obtained signifieant improvements in both ASIA grading （3 grade C, 10 grade D and 13 grade E） and ASIA scoring （92.5 ± 8.6 points） （ P 〈 0. 05） . Conclusion The technique of atlantoaxial transartiealar serew fixation shouht be reeomnlended for the treatment of atlantoaxial instability, because it is simple, cheap, reliable, and effective.