寰枢椎后路融合术治疗齿状突骨折并寰枢椎脱位

C_(1-2)Posterior Cervical Fusion for Obontoid Fracture Associated with Atlantoaxial Dislocation

目的：探讨３种寰枢椎后路融合术治疗齿状突骨折并寰枢椎脱位的临床效果。方法：对１８例齿状突骨折并寰枢椎脱位患者行寰枢推后路融合术：包括Ｇａｌｌｉｅ钢丝法７例，Ｂｒｏｏｋｓ钢丝法７例，Ａｐｏｆｉｘ椎板夹内固定法４例。结果：术后１６例寰枢椎脱位完全复位，２例大部分复位（复位不满意才另行枕颈融合，不在此列）。经０．５～１０年（平均４．５年）随访，除１例术后６个月死亡外，其余１７例均获骨性融合，其中钢丝断裂而植骨已融合１例，寰椎后弓钢丝切割断裂移位后融合１例；所有患者颈痛全部消失；８例有脊髓病症状者中，１例无改善（术前ＪＯＡ评分分别为５分），其余７例ＪＯＡ评分均较术前提高，分别为１３～１７分。结论：３种寰枢椎后路融合术均有其适用性，是治疗齿状突骨折并寰枢椎脱位的有效方法；ＡｐｏｆｉＸ椎板夹为寰枢推后路融合术的首选内固定方式；术前牵引复位是手术成功的关键。

Objective:To evaluate the clinical effects of 3 different techniques for posterior atlantoaxial fusion in treating odontoid fracture associated with atlantoaxial dislocation. Methods: 18 patients of odontoid fracture associated with atlantoaxial dislocation were treated with C1-2posterior cervical fusion,including 7 Gallie fusion,7 Brooks fusion and 4 Apofix interlaminar clamp applications. Results: After operation,atlantoaxial dislocation was reduced completely in 16 patients. The patients were followed postoperatively for 0. 5-10 years (average=4. 5 years). 17 patients had ossious unions except one who died six months affter operation. Neck pain disappeared completely in 15 patients,and other 2 showed significant improvement. Of & patients with myelopathy(5-12 points in JOA score), 7 had improve. ment(13-17 points in JOA score) and onefailed to improve. Conclusions: The 3 techeniques are all effective and suitable for odontoid fracture associated with atlantoaxial dislocation. Apofix interlaminar clamp is the best choice for posterior atlantoaxial fusion. Anatomic reduction is an important measure for successful operation.