寰椎椎弓螺钉在寰枢椎不稳中的临床应用

CLINICAL APPLICATION OF ATLAS TRANSLAMINAR SCREWS FIXATION IN TREATMENT OF ATLATOAXIAL INSTABILITY

目的探讨寰椎椎弓螺钉内固定技术在寰枢椎不稳中应用的技巧与临床疗效。 方法 2007年3月－2009年8月，32例因寰枢椎不稳行后路寰枢椎椎弓根螺钉固定融合的患者中，7例因骨折类型、解剖变异及术中原因改行单侧或双侧寰椎椎弓螺钉固定，共植入9枚寰椎椎弓螺钉。男5例，女2例；年龄35～69岁，平均48.2岁。致伤原因：交通事故伤4例，高处坠落伤2例，重物砸伤1例。单纯齿状突骨折2例（AndersonⅡ型）；合并寰椎侧块骨折2例，寰枢关节前脱位1例，Hangman骨折2例。受伤至手术时间4～9 d，平均6 d。术前日本骨科协会（JOA）评分为（8.29 ± 1.60）分。 结果术后复查颈椎侧位及张口位X线片示螺钉位置满意。手术切口均Ⅰ期愈合；无脊髓和椎动脉损伤发生。7 例均获随访，随访时间9～26个月，平均14个月。术后X线片示植骨块均获骨性融合，融合时间6～11个月，平均8 个月。无螺钉松动、移位、断裂和寰枢椎再移位、失稳现象发生，寰椎椎管和脊髓未见侵犯。术后6个月JOA评分为（15.29 ± 1.38） 分，与术前比较差异有统计学意义（t=32.078，P=0.000）。 结论寰椎椎弓螺钉内固定技术固定牢固，操作简便、安全，可作为寰椎椎弓根或侧块螺钉固定失败的补救方案。

ObjectiveTo explore the effectiveness of fixation of atlas translaminar screws in the treatment of atlatoaxial instability. MethodsA retrospective analysis was made on the clinical data of 32 patients with atlatoaxial instability treated with atlantoaxial trans-pedicle screws between March 2007 and August 2009. Of them, 7 patients underwent atlas translaminar screws combined with axis transpedicle screws fixation because of fracture types, anatomic variation, and intraoperative reason, including 5 males and 2 females with an average age of 48.2 years （range, 35-69 years）. A total of 9 translaminar screws were inserted. Injury was caused by traffic accident in 4 cases, falling from height in 2 cases, and crushing in 1 case. Two cases had simple odontoid fracture （Anderson type II）, and 5 cases had odontoid fracture combined with other injuries （massa lateralis atlantis fracture in 2, atlantoaxial dislocation in 1, and Hangman fracture in 2）. The interval between injury and operation was 4-9 days （mean, 6 days）. The preoperative Japanese Orthopaedic Association （JOA） score was 8.29 ± 1.60. ResultsThe X-ray films showed good position of the screws. Healing of incision by first intention was obtained, and no patient had injuries of the spinal cord injury, nerve root, and vertebral artery. Seven cases were followed up 9-26 months （mean, 14 months）. Good bone fusion was observed at 8 months on average （range, 6-11 months）. No loosening, displacement, and breakage of internal fixation, re-dislocation and instability of atlantoaxial joint, or penetrating of pedicle screw into the spinal canal and the spinal cord occurred. The JOA score was significantly improved to 15.29 ± 1.38 at 6 months after operation （t=32.078, P=0.000）. ConclusionAtlas translaminar screws fixation has the advantages of firm fixation, simple operating techniques, and relative safety, so it may be a remedial measure of atlatoaxial instability．