后路寰枢椎防旋转钉棒固定融合寰枢椎脱位

Posterior atlantoaxial anti-rotation screw rod fixation and fusion for atlantoaxial dislocation

[目的]介绍后路寰枢椎防旋转钉棒固定融合寰枢椎脱位的手术技术和初步临床效果。[方法] 2018年6月—2022年6月采用后路寰枢椎固定融合术治疗可复性寰枢椎脱位16例。全麻后行颈后正中切口,C1行椎弓根螺钉或部分经椎弓根螺钉固定,C2行椎弓根螺钉或椎板螺钉固定,再直接置入预弯的防旋转连接棒,形成寰枢椎防旋转钉棒系统内固定,完成提拉复位,最后自体髂骨植骨融合,术后定时随访并评估寰枢椎复位、植骨融合以及神经功能情况。[结果]16例患者均成功完成手术,术中无神经、血管损伤等并发症。术后患者症状明显改善,影像学提示寰枢椎复位满意,ADI由术前的(5.7±1.3)mm减小至术后1周的(1.7±0.7)mm,JOA评分由术前的(13.7±1.1)分提高至术后1周的(16.3±0.9)分,术后随访3~24个月,所有患者均获寰枢椎间骨性融合。[结论]后路寰枢椎防旋转钉棒固定融合寰枢椎脱位初步临床疗效满意,术中操作更加便利,但仍需进一步与寰枢椎常规钉棒系统对比,以验证其优势。

[Objective]To introduce the surgical technique and preliminary clinical outcomes of posterior atlantoaxial anti-rotationscrew rod fixation for atlantoaxial dislocation.[Methods]From June 2018 to June 2022,16 patients underwent abovesaid surgical proce-dures for reversible atlantoaxial dislocation.As posterior midline incision was performed under general anesthesia,the pedicle screws or par-tial transpedicle screws were placed on the C1,while pedicle screws or laminar screws were placed on the C2.Subsequently,the pre-curvedanti-rotation rods were installed to construct the atlanto-axial anti-rotation screw rod system for lifting,reducing and fixing C1~C2.Finally il-iac autogenous bone graft was implanted for C1~C2 fusion.After operation,the atlantoaxial reduction,fusion,and neurological function wereevaluated in regular intervals.[Results]All the 16 patients had the operation completed successfully with no complications,such as nerveand vascular injury.The patients got symptoms improved significantly after surgery,with satisfactory atlantoaxial reduction on images.TheADI decreased from(5.7±1.3)mm before surgery to(1.7±0.7)mm one week after surgery,whereas the JOA score increased from(13.7±1.1)before surgery to(16.3±0.9)one week after surgery.At the latest follow-up lasted from 3 to 24 months,all patients achieved atlanto-axialbony fusion.[Conclusion]The posterior atlantoaxial instrumented fusion with this anti-rotation screw-rod system for atlantoaxial disloca-tion does achieve satisfactory short-term clinical consequence with an advantage of more convenient surgical operation.However,furthercomparison with the conventional atlantoaxial screw system is needed to verify its advantages.