寰椎后弓椎板钩联合枢椎椎弓根螺钉固定治疗游离齿状突并可复性寰枢椎脱位

Laminar hooks of Cl posterior arch combined with C2 pedicle screws in the treatment os odontoideum and reducible atlantoaxial islocation

背景：游离齿状突并可复性寰枢椎脱位常需要手术治疗，但目前缺乏操作简单且安全有效的寰枢椎内固定方式。 目的：评估寰椎后弓椎板钩联合枢椎椎弓根螺钉固定植骨融合治疗游离齿状突并可复性寰枢椎脱位的疗效。 方法：回顾性分析2005年7月至2012年6月采用寰椎后弓椎板钩联合枢椎椎弓根螺钉固定自体髂骨植骨融合术治疗游离齿状突并可复性寰枢椎脱位患者l1例。对脱位复位情况、内固定植骨融合率、JOA功能评分、影像学评估及术后并发症等进行分析。 结果：11例术中均未发生椎动脉和脊髓损伤。术后均获得随访，随访时间为12~37个月，平均25个月，均未发生内固定物松动、断裂，术后疼痛和神经症状均得到缓解，术后JOA评分较术前明显改善（P＜0.01），寰枢椎均融合。 结论：寰椎后弓椎板钩联合枢椎椎弓根螺钉固定植骨融合术治疗游离齿状突并可复性寰枢椎脱位是一种安全有效的方法。

Background：Surgical treatment is essential for os odontoideum combined with reducible atlantoaxial dislocation, but a sim-ple, safe and effective atlantoaxial internal fixation has not been developed. Objective：To evaluate the curative effect of internal fixation and fusion with laminar hooks of C1 posterior arch and C2 ped-icle screws for os odontoideum combined with reducible atlantoaxial dislocation. Methods：From July 2005 to June 2012, 11 patients with os odontoideum and reducible atlantoaxial dislocation were treated by internal fixation with laminar hooks of Cl posterior arch combined with C2 pedicle screws and autogenous iliac bone graft. The dislocation reduction, bone fusion rate, JOA functional score, radiological feature and postoperative complica-tions were retrospectively analyzed. Results： No vertebral artery injury and spinal cord injury occurred during operation. The mean follow-up period was 25 months in all 11 patients （ranging from 12 to 37 months）. No loosening and breakage of internal fixation were observed af-ter surgery. Pain and neurologic symptoms were relieved. JOA score was significantly increased as compared with preopera-tive one （P＆lt;0.01）. Atlantoaxial fusion was seen in all the cases. Conclusions：The fixation and fusion with laminar hooks of Cl posterior arch and C2 pedicle screws is safe and effective for os odontoideum combined with reducible atlantoaxial dislocation.