后路钉棒系统在经寰枢椎椎弓根治疗可复性寰枢椎不稳定中的应用

Using of axial screw-rod system via vertebrae pedicle screw of the atlas and axis for treatment of reducible atlanto-axial instability

目的评价颈椎后路钉棒系统治疗可复性寰枢关节不稳的临床疗效。方法 2006年1月-2010年1月共收治32例寰枢关节失稳患者,男,19例,女,13例,平均年龄42.2岁。术前行床边颅骨牵引2周,并床边照片,见寰枢关节可经牵引复位,再行后路寰枢椎椎弓根螺钉钉棒系统内固定术。根据SYMON-LAVENDER临床标准、JOA脊髓功能评定标准和影像学颈髓延髓角的改善情况进行疗效评定。结果 32例寰枢关节均获良好复位。平均随访24个月,所有植骨均获得骨性融合。术后按SYMON-LAVENDER标准,总体有效率为87.5%。JOA评分由术前(8.6±2.1)分,改善为术后(14.8±3.1)分,改善率为74.0%。平均颈髓延髓角由110.5°,改善为148°。结论后路寰椎椎弓根螺钉内固定术具有直视,短节段固定,融合率高等优点,是治疗可复性寰枢关节失稳的安全有效方法。

[Objective ] To evaluate the efficacy of axial screw-rod system via vertebrae pedicle screw of the atlas and axis for treatment of atlanto-axial instability. [Method] 32 patients （19 males, 13 females） with atlanto-axial instability from January 2006 to January 2010. The mean age was 42.2 years. The mean JOA score was （8.6±2.1） with the mean cervieomedullary angle of 110.5°. All the patients were given skull traction before the surgery to make sure all the Atlanto-axial instabilities were reducible. Then posterior approach screw-rod system fixation via the posterior arch of the atlas was performed. Symon and Lavender clinical standard, JOA scoring and cervicomedullary angle imaging index were used to evaluate the therapeutic effect. [Result] The follow-up period ranged from 12 to 48 months （average 24 months）. All patients had good reduction of C1-2. Moreover Clinical efficient plus excellence rate was 87.5% according to the Symon and Lavender clinical standard. The mean JOA score was （14.8±3.1） with the mean cervicomedullary angle of 148°. Solid bony fusion was evidenced in all patients ultimately. [ Conclusion] Using axial screw-rod system through vertebrae pedicle screw of the atlas and axis is safe, simple and effective in managing patients with atlanto-axial unsteadiness.