枢椎椎板螺钉内固定技术治疗寰枢椎不稳的临床应用

Clinical application of internal fixation technique with C2 translaminar screws for treatment of at- lantoaxial instability

目的探讨应用枢椎椎板螺钉内固定技术治疗寰枢椎不稳的临床疗效。方法回顾性分析2007年7月至2011年10月应用枢椎椎板螺钉内固定技术治疗的26例患者的临床资料，AndersonⅡ型和Ⅲ型齿状突骨折21例，先天性游离齿状突并襄枢椎不稳3例，寰椎横韧带断裂2例。所有患者经影像学证实均有寰枢椎不稳或半脱位，临床表现为不同程度的颈枕区疼痛、活动受限等。内固定系统均采用颈后路Vertex钉棒系统。结果26例患者共置入枢椎椎板螺钉49枚，术中无一例发生脊髓损伤、椎动脉损伤等并发症。患者获得6—26个月的随访，平均17个月。术后患者临床症状均得到不同程度的改善，数字化DR、CT复查螺钉位置良好，无松动、断钉，未见明显复位丢失，所有患者均于术后3—4个月获得骨性融合。结论应用枢椎椎板螺钉内固定技术治疗寰枢椎不稳效果满意，操作简单、安全，可以作为传统枢椎内固定的一种补充方法。

Objective To investigate the clinical effect of internal fixation technique with C2 translaminar screws on atlantoaxial instability. Methods From July 2007 to October 2011, the clinical data of 26 patients with atlantoaxial instability underwent internal fixation technique with C2 translaminar screws were retrospectively analyzed. There were 21 cases of Anderson type Ⅱ and Ⅲ odontoid fractures, 3 cases of congenital loose odontoid combined with atlantoaxial instability, and 2 cases of axis transverse ligament rupture. All patients had the symptoms of atlantoaxial instability or subluxation, such as cranio- cervical junction pain, activity limitation. Posterior vertex screw rod system was used for internal fixation. Results A total of 49 C2 translaminar screws were placed in the 26 patients. There were no complica- tions, such as spinal cord injury or vertebral artery injury during operation. All patients were followed-up for 6 -26 months, average 17 months. The clinical symptoms were improved in different degrees after op- eration, and all screws had good position reviewed by digital DR and CT scans. No cases of screw loose- ning or nail broken were observed, no obvious reset loss, all patients had bone healing at 3 to 4 months after operation. Conclusions The effect of internal fixation technique with C2 translaminar screws on at- lantoaxial instability is good, and the surgical procedure is simple and safe, so it can be a supplementary method for traditional C2 internal fixation.