后路改良经关节螺钉内固定术治疗寰枢椎不稳定

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1、后路改良经关节螺钉内固定术治疗寰枢椎不稳定作者：蔡贤华，陈庄洪，黄继锋，黄卫兵，刘曦明，徐峰，王庆【摘要】[目的]探讨寰枢椎不稳定的手术方法与疗效。[方法]采用以枢椎下关节突下缘中点为进钉点的后路改良经关节螺钉内固定加自体颗粒样松质骨植骨术治疗寰枢椎不稳定20例，其中，新鲜外伤4例，陈旧性外伤14例，先天性畸形1例，椎管内肿瘤1例。术后定期观察椎体复位、内固定、骨融合、临床表现变化及并发症发生情况。[结果]双侧螺钉内固定20例，加后路钢丝固定3例。寰枢椎获解剖复位19例，大部分矫正1例，内固定位置均良好。随访16～64个月，寰枢椎于术后2～3个月均获得骨性融合，临床症

2、状缓解，无并发症发生。[结论]后路改良经关节螺钉内固定术，操作简便，疗效可靠，可作为治疗寰枢椎不稳定的有效术式。【关键词】寰枢椎不稳定;经关节螺钉固定;手术;颈椎融合　　Abstract:[Objective]Toexplorethetechniquesandeffectofatlantoaxialinstabilitywithposteriortransarticularscrewfixation.[Method]AprospectiveclinicalanalysiswasperformedfortheresultsofthemodifiedposteriorC1

3、、2transarticularscrewfixation,inwhichthemiddlesite11oflowermarginintheaxialinferiorarticularprocesswasusedasthescrewentrypointintheprocedure.TwentycasesofatlantoaxialinstabilityunderwentthemodifiedC1、2stabilizationwithmorselizedautograftfromSeptember2001toSeptember2006.Therewere15malesa

4、nd5females,averaged32.2years(range17to49years).Ofthem,4casessufferedfromfreshinjuries,14fromoldtrauma,1fromcongenitaldeformity,and1fromintraspinaltumor.Postoperativeindexesincludingthereductionextentofvertebralbody,internalfixation,bonefusion,clinicalsymptomsandtheircomplicationwereobse

5、rvedperiodically.[Result]Bilateralscrewfixationwasusedalonein17cases,withGallieinterspinouswiringforaddedstabilityin3.Anatomicalreductionoftheatlantoaxialjointswasachievedin19cases,whilerotationaldislocationwasrestoredtoagreatextentin1.Fixationofalltheinternaldeviceswasverywellinthegrou

6、p.Allcaseswerefollowedupfrom16to64months(21monthsonaverage).C1、2bonyfusionwasobtainedinpostoperative2to3months,clinicalsymptomsrelievedandnocomplicationsoccurred.[Conclusion]ThemodifiedposteriortransarticularscrewfixationusingnewscrewentrysiteisrecommendedasaneffectivetreatmentforC1、2in

7、stabilityduetoitssimpleprocedureandsatisfyingcurativeeffect.11　　Keywords：atlantoaxialinstability;posteriortransarticularscrewfixation;operation;cervicalfusion　　寰枢椎不稳定常因上颈椎外伤、畸形、退变、肿瘤及感染等而引起，一旦发生，脊髓神经或椎动脉受到压迫或动态刺激，患者即处于高度危险状态[1]。经典的寰枢椎后方经关节螺钉内固定术(即Magerl手术)是其较理想的治疗方法[2、3]，但研究发现，