寰枢椎不稳颈后路手术治疗(ni bin)

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1、寰枢椎不稳的颈后路手术治疗第二军医大学长征医院骨科倪斌【摘要】目的对寰枢椎不稳的颈后路手术治疗进行探讨。方法本组共78例，其中男性57例，女性21例。年龄3～78岁，平均42岁。本组包括齿突骨折（新鲜骨折、陈旧骨折、骨不连）38例，齿突游离小骨15例，横韧带断裂8例，C1-2肿瘤6例，枕颈发育畸形6例，陈旧性寰椎椎弓骨折5例。78例均行颈后路手术，包括：枕颈融合术32例，其中单纯植骨融合11例，辅以CD－Cervical内固定11例，Cervifix内固定10例。寰枢椎融合46例，在钢丝钛缆内固定37例中，有9例同时行C1-2经关节间隙螺钉内固定术。Apofix椎板夹内固定9例。

2、结果78例均得到随访，随访6月～18年，平均3.2年。75例获得骨性愈合，不愈合3例。术前合并神经症状38例，术后临床症状消失或基本消失者20例，明显改善11例，轻度改善3例，无改善2例，加重2例。结论对于C1-2骨折脱位、畸形、肿瘤、横韧带断裂等引起的寰枢椎不稳，应早期进行后路融合手术。充分控制寰枢椎活动、精心准备植骨床是手术成功的主要措施。PosteriorapproachoperationofatlantoaxialinstabilityNIBin,etal.DepartmentofOrthopedics,ChangzhengHospital,SecondMilitaryM

3、edicalUniversity,Shanghai20003.China【Abstract】ObjectiveToinvestigatetheresultsofsurgicaltreatmentofatlantoaxialinstability.MethodsSeventy-eightpatientswithatlantoaxialinstabilitywerecollected,Including38patientswithunstableodontoidfractures,15patientswithosodontoideum,8patientswithadisruptedt

4、ransverseligament,6patientswithC1-2tumor,6patientswithCongenitalOccipitocervicalabnormalities,5patientswitholdJeffersonfractures.Fifty-sevenofthemweremaleandtwenty-onewerefemale.Themeanageofthepatientswas42years(ranged3～78years).Allpatientsweretreatedbyoperation.Thirty-sevenpatientswereoperat

5、edbyatlantoaxialarthrodesisusingwirefixationwithautologousbonegrafts.NinepatientsofthemweretreatedbyC1-2posteriorwiringfixationandtlantoaxialfacetscrewfixation.Ninepatientswereoperatedbyatlantoaxialarthrodesisusingapofixinterlaminarclampingwithautologousbonegrafts.Occipitocervicalfusionwasper

6、formedin31thirty-onepatientsarthrodesissimplewithautologousbonegraftsandexternalfixationwasusedin10patients.CD-Cervicalfixationwasusedin11patients.Cervifixfixationwasusedin10patients.ResultsThepatientswerefollowedupforaverageofthreeyearandtwomonths(range6～216months).Solidarthrodesiswasobtaine

7、dinthe75patientsandnon-uniondevelopedin3cases.Allnon-unioncasesoccurredwithoccipitocervicalfusion.ConclusionPosteriorfusionisrecommendedforatlantoaxialinstabilityduetotraumaticfractureorligamentousdisruption,tumor,inflammatory,skeletaldysplas