改良寰椎侧块螺钉-枢椎椎弓根螺钉结合后方寰枢椎张力带固定治疗创伤性寰枢关节不稳

Improved lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band fixation for traumatic atlantoaxial instability

目的 探讨经后路寰椎侧块螺钉-枢椎椎弓根钉棒结合后方寰枢椎张力带固定治疗寰枢关节不稳的临床疗效. 方法 2007年10月-2012年10月采用后路寰椎侧块螺钉-枢椎椎弓根螺钉结合后方寰枢椎张力带固定治疗创伤性寰枢关节不稳患者23例,其中男15例,女8例;年龄32 ～61岁[（42.6±2.7）岁].齿状突骨折合并寰枢关节半脱位11例,寰椎前脱位5例,寰枢关节旋转半脱位7例.所有患者术前均存在明显的枕颈部疼痛及活动受限,但不合并感觉运动障碍.完成寰枢椎固定后同期行寰枢椎后方植骨融合,植骨材料选用自体髂骨或同种异体松质骨条.术后3,6,12个月分别随访1次,之后每年随访1次,了解内固定及植骨融合情况.结果 手术时间120～ 150 min[（131.7±25.4） min],失血量320 ～600 ml[（417.6 ±53.4）ml].术中无死亡及损伤血管神经等并发症发生.术后随访12 ～36个月[（20.7±3.1）个月],无内固定松动及断裂.术后1年内寰枢椎植骨均获满意骨性融合. 结论 寰椎侧块螺钉-枢椎椎弓根螺钉结合后方寰枢椎张力带固定技术是治疗创伤性寰枢关节不稳的可靠、有效方法.

Objective To investigate the clinical effects of modified posterior lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band for treatment of atlantoaxial instability.Methods From October 2007 to October 2012,23 cases of atlantoaxial instability were immobilized with modified posterior lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band.There were 15 males and 8 females with mean age of （42.6 ± 2.7） years （range,32-61 years）.Eleven cases were diagnosed as odontoid process fracture combined with atlantoaxial joint dislocation,5 as anterior dislocation of the atlas,and 7 as atlantoaxial joint rotary subluxation.All cases suffered from notable occipitocervical pain and activity restriction,but with no neurological deficit.After atlantoaxial fixation,concurrent posterior fusion was done with iliac autograft or cancellous bone allograft.Follow-up was made at postoperative 3,6,and 12 months,followed by once a year.Results Mean operation time was 120-150 min [（131.7 ± 25.4） min] and mean bleeding was 320-600 ml [（417.6 ± 53.4）ml].All cases went through operations without the occurrence of death or complications months of follow-up （range,12-36 months）.All cases obtained bony fusion one year after operation.Conclusion Lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band can be feasible and safe in treatment of traumatic atlantoaxial instability.such as nerve blood vessel injury.No implant loosening or breakage occurred after mean （20.7 ± 3.1） months of follow-up （range, 12-36 months）. All cases obtained bony fusion one year after operation. Conclusion Lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band can be feasible and safe in treatment of traumatic atlantoaxial instability.