枕颈融合内固定治疗颅颈交界区不稳的疗效分析

Clinical effects of the treatment of atlantoaxial dislocation by posterior occipitocervical fixation with C2 pedicle screws and occipitocervical plate systems

目的观察枕骨板联合枢椎椎弓根螺钉治疗颅颈交界区不稳的疗效。方法对47例颅颈交界区不稳患者行枕骨钛板联合枢椎椎弓根螺钉治疗，采用JOA评分、Frankel分级及影像学检查评价手术效果。结果所有患者随访12～33个月，平均24．6个月。随访结束时Frankel分级：B级中2例均改善到c级，c级4例中有3例改善到D级，D级29例中27例改善到E级，其余3例改善不明显。术后JOA评分法评分7～15分，平均13．4分。脊髓功能改善率平均为77．3％；其中优27（57．4％）例，良16（34．0％）例，有效4（8．5％）例。影像学复查45例患者成功获得骨性融合，2例经再次植骨后获得骨性融合。X线片观察未发现有断棒和断钉等现象。1例枕骨板螺钉松动，因无症状未予处理。后也获得骨性融合。结论采用枕骨钛板联合枢椎椎弓根螺钉治疗颅颈交界区不稳疗效确切。

Objective To observe the clinical effect of posterior occipitocervical fixation using C2 pedicle screws and oc- cipitocervical plate systems. Methods Totally 47 patients with atlantoaxial dislocation were treated with posterior occipitocervical fixation using C2 pedicle screws and occipitocervical plate systems. The clinical effect was evaluated with JOA scores ,Frankel system and image examination. Results All the patients were followed up for 12 -33 months, average 24.6 months. Frankle classification of postoperative neurofunctional recovery ： 2 cases recovered from grade B to grade C, 3 cases of 4 patients recovered from grade C to grade D, 27 cases of 29 patients recovered from grade D to grade E and 3 cases had no improved. JOA scores after operation was from 7 - 15 scores, averagel3.4 scores. The improving rate of neurological function was 77.3%. The excellent cases were 27 （57.4%） , good cases were 16 （34.0%） and effec- tive cases were 4（8.5% ）. Image examination showed all patients exhibited a stiff bone fusion. There were no internal fixation loosing,rupture,mobiled and screw pulled out. Conclusion Posterior occipitocervical fixation using C2 pedicle screws and occipitocervical plate systems has a definite therapeutic effect on atlantoaxial dislocation.