经寰枢椎椎弓根内固定治疗可复性寰枢椎不稳

目的：探讨经寰枢椎椎日根内固定治疗可复性寰枢椎不稳的临床疗效。方法：回顾性分析我院经椎5根内固定治疗的可复性寰枢椎不稳患者16例，其中男11例，女5例。齿状突陈旧性骨折2例，新鲜Ⅱ型齿状突骨折6例，游离齿状突伴寰枢椎陈旧性脱住2例，齿状突骨折伴寰枢椎脱位2例，侧块完整Jefferson骨折2例，Hang．man骨折2例，所有伴脱位患者经颅骨牵引均可复位。采用JOA行手术前后脊髓功能评定。结果：所有患者均顺利置钉，无脊髓及椎动脉损伤，植骨全部融合，无内固定断裂及松动。患者神经功能均有不同程度的改善，手术前后JOA评分改善率平均为85％。结论：经寰枢椎椎弓根内固定可为寰枢椎不稳的治疗提供良好的三柱稳定固定，只要术前根据CT做好钉道设计，螺钉置入遵循个体化原则，置钉的安全性是可靠的。

Objective To investigate the clinical efficacy of atlantoaxial pedicle screw fixation to reusable atlantoaxial instability. Methods 16 cases with reusable aflantoaxial in- stability, including 11 males and 5 females, retrospectively analyzed in our hospital. Among them, old odontoid fracture was in two cases, fresh II odontoid fracture in 6, free dens with old aflantoaxial dislocation in 2, odontoid fracture with atlantoaxial dislocation in 2, Jefferson fracture with complete lateral mass in 2, and Hangman fracture in 2. All patients combined dislocation can be reset through skull traction. The spinal cord function was assessed before and after surgery according to JOA score. Results：All patients were successfully set screw, no spinal cord and vertebral artery injury was occurred, all bone graft was fused, and fixation was not loose and broken. Neurological function was improved in all patients. JOA score was improved with averaged recovery rate 85%. Conclusion Good three columns fixation was provided to atlantoaxial instability by atlantoaxial pedicle. The safety of pedicle screw placed is reliable of designing screw channel based on CT and following individual screw placement.