CT监测下经皮穿刺寰枢椎侧块关节植骨融合术

CT-guided percutaneous puncture for atlantoaxial lateral mass arthrodesis with bone graft

目的报告自行设计的CT监测下经皮穿刺寰枢椎侧块关节植骨融合术并探讨其临床应用。方法在对56具成人寰枢椎干燥骨标本行解剖学研究的基础上,1999年3月～2001年3月,9例寰枢椎脱位患者经牵引复位后,采用Halo-Vest外固定架固定4例,前路经枢椎体寰椎侧块螺钉内固定5例。在CT监测下,应用自行研制的手术器械,后外侧入路经皮穿刺将寰枢椎侧块关节后外侧的关节囊、关节软骨去除,做好植骨床并将用穿刺法钻取的髂骨松质骨骨柱植入。结果9例术后随访2～17个月,平均12.7个月,其中8例超过6个月。3例术后3个月去除了Halo-Vest架。8例均摄过伸、过屈及张口位X线片,显示寰枢椎稳定;其中6例在术后3～4个月行CT扫描及三维重建显示侧块关节达到植骨融合。结论此术式为创新设计,其创伤小,出血少,融合时间相对缩短,融合率高。

Objective To report a new designed technique of CT-guided percutaneous puncture for atlantoaxial lateral mass arthrodesis with bone graft and discuss its clinical usefulness and effect. Methods From March 1999 to March 2001, on the base of anatomical investigation of 56 adult cadaversatlas and axis bone specimens, 9 cases with instability of atlantoaxial were treated after reduction by traction, 4 of 9 cases underwent Halo-Vest immobilization, and the other 5 cases underwent transarticular screw fixation through C2 vertebral body for atlantoaxial instability. Of all nine cases, the articular cartilage and capsule of post lateral part of atlantoaxial joints were removed by using home made surgical instruments under CT guidance. Iliac cancellous bones obtained by puncture were implanted into the joint space. Results All cases were followed up from 2 to 17 months (average 12.7 months) and 8 cases more than 6 months. Generally, at the third to fourth month after operation, CT scan showed bony union of the grafted bone and the excessive extension and flexion X-ray films showed stable movement of the atlantoaxial joints, and then the Halo-Vest stock were removed. Conclusion This technique has obvious advantages of less trauma and hemorrhage, high union rate, easy, safe and efficiencies.