寰椎椎板钩联合枢椎椎弓根螺钉治疗寰枢椎失稳的临床疗效

Clinical effect of C_1 laminar hooks and C_2 pedicle screws fixation for atlantoaxial instability

目的探讨后路寰椎椎板钩联合枢椎椎弓根螺钉技术治疗寰枢椎失稳的临床疗效。方法 2009年12月-2012年12月,行后路寰椎椎板钩联合枢椎椎弓根螺钉固定技术的寰枢椎失稳患者,有效随访资料36例,其中男26例,女10例;年龄21-66岁,平均42.3岁;有脊髓损伤症状者28例,日本骨科学会（Japanese Orthopaedic Association,JOA）评分9.3±1.8;有颈枕区疼痛症状者30例,颈枕区视觉模拟量表（visual analog scale,VAS）评分3.9±1.1;36例患者颈椎障碍功能指数（neck disability index,NDI）术前27.6±8.3;有发作性眩晕症状者6例;寰枢椎脱位26例,术前均行颅骨牵引术并达到复位。结果所有患者均顺利完成手术。术中出血量为80-600 mL,平均295 mL;手术时间95-210 min,平均157 min。术后随访个6-42个月,平均21个月,35例术后6月获得融合,影像学检查可见连续骨小梁,植骨融合率97.2%。末次随访JOA评分改善至13.7±2.0,平均改善率58%;术后VAS评分1.8±0.9;NDI降低至12.9±6.4。JOA评分、VAS评分和NDI评分术前与术后对比差异均具有统计学意义（P〈0.05）。术中未出现椎动脉、脊髓神经损伤或脑脊液漏等并发症。随访期间未发现椎板钩脱位、松动,6例有发作性眩晕患者眩晕症状消失。结论寰椎椎板钩联合枢椎椎弓根螺钉技术手术操作简单、风险低,手术时间短,有良好临床的效果,可作为治疗寰枢椎失稳的一种选择。

Objective To explore the clinical effect of C1 laminar hooks and C2 pedicle screws fixation for atlantoaxial instability. Methods From December 2009 to December 2012,36 patients with atlantoaxial instability were treated by C1 laminar hooks and C2 pedicle screws fixation. There were 26 males and 10 females aged 21 to 66 years with an average 42. 3years. There were 28 cases with symptoms of spinal cord injury,the preoperative Japanese Orthopaedic Association（ JOA）scores were 9. 3 ± 1. 8; 30 cases underwent cervical occipital pain,the visual analog scale（ VAS） scores were 3. 9 ± 1. 1; the preoperative neck disability index（ NDI） scores were 27. 6 ± 8. 3; 6 cases with paroxysmal vertigo; 26 cases with atlantoaxial dislocation underwent skull traction before the operation. Results The operations on all patients were successful. The average intraoperative blood loss was 295 mL（ rang 80 - 600 mL）,with an average operative time 157 min（ range 95 - 210 min）.The mean follow-up duration was 21 months（ range 6 - 42 months）,6 months after operation,solid bony fusion were obtained in 35 cases,the rate of bone graft fusion was 97. 2%. At the final follow-up,the JOA scores were 13. 7 ± 2. 0,the VAS scores were 1. 8 ± 0. 9,the NDI scores were 12. 9 ± 6. 4. The differences of JOA scores,VAS scores and NDI scores between preoperative and postoperative were statistically significant. There were no vertebral artery,spinal cord injury occurred intraoperation. During the follow-up period,no hooks loosening or displacement occurred. Conclusion Good clinical effect can be achieved by the C1 laminar hooks and C2 pedicle screws fixation,and it can be used for atlantoaxial instability.