寰枢钉棒在合并寰枕融合的寰枢脱位治疗中的应用

APPLICATION OF C_1 LATERAL MASS-C_2 PEDICLE SCREW-ROD INSTRUMENT IN TREATMENT OF ATLANTOAXIAL DISLOCATION WITH ATLANTO-OCCIPITAL FUSION AND BASILAR INVAGINATION

目的探讨寰椎侧块-枢椎椎弓根螺钉-棒复位内固定技术治疗合并寰枕融合及颅底凹陷的寰枢椎脱位的可行性及临床疗效。方法回顾性分析93例2013年2月—2015年3月我院神经外科收治的合并寰枕融合及颅底凹陷的寰枢椎脱位病人的临床资料。所有病例均采用寰椎侧块-枢椎椎弓根螺钉-棒复位内固定系统行寰枢复位内固定,并取髂后上棘松质骨颗粒植骨融合。结果术中均未发生血管及神经功能损伤。术后CT检查显示85例达到了水平方向的完全复位,86例获得了垂直方向的完全复位。82例完成了6~18个月的随访,随访CT检查示所有病人均达到了骨性愈合,MR检查示齿状突对脑干及延髓的压迫均得到了解除。术后JOA评分与术前比较,差异有显著性(P<0.05)。结论寰椎侧块-枢椎椎弓根螺钉-棒复位内固定技术治疗合并寰枕融合及颅底凹陷的寰枢椎脱位是有效且安全可行的。

Objective Toinvestigate the surgical feasibilityand clinicaleffectof C1 lateralmass-C'2pediclescrew-rodin-strument inthetreatment of atlantoaxialdislocationwithatlanto-occipital fusionand basilarinvagination.Aretrospec-tive analysis was performedon the clinicaldataof 93patientswithatlantoaxialdislocationwithatlanto-occipitalfusionandbasilar invagination whowere admittedto the Department ofNeurosurgeryofourhospitalfrom February2013to March2015.Forall pa-tients,the C1 lateral mass-C'2 pedicle screw-rod instrument was used for the reduction and fixation of atlantoaxial dislocation,and cancellous boneparticleswereharvestedfromthe posteriorsuperior iliacspineforbonegrattfusion.Noneurovascular injury occurred during surgery.Postoperative computed tomography(C'T)showed that complete horizontal reduction was achieved in 85 cases,and complete vertical reduction was achieved in 86 cases.Follow-up(6 to 18 months)was performed in 82 patients;C'T and magnetic resonance imaging showed bony fusion and relief of compression of the brainstem and medulla oblongata by the odontoid,respectively,inthe82patients.Inaddition,JOAscoresimprovedsignificantlyaftersurgery(P<0.05).The C1lateralmass-C'2pediclescrew-rod instrumentis a promising technique forthe treatmentofatlantoaxialdislocation withat-lanto-occipital fusion and basilar invagination.