寰枢椎不稳颈后路手术治疗(ni bin).docVIP

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，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。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。 Posterior approach operation of atlantoaxial instability NI Bin, et al.Department of Orthopedics, Changzheng Hospital,Second Military Medical University,Shanghai 20003.China 【Abstract】 Objective To investigate the results of surgical treatment of atlantoaxial instability.Methods Seventy-eight patients with atlantoaxial instability were collected,Including 38 patients with unstable odontoid fractures,15 patients with os odontoideum,8 patients with a disrupted transverse ligament,6 patients with C1-2 tumor,6 patients with Congenital Occipitocervical abnormalities,5 patients with old Jefferson fractures.Fifty-seven of them were male and twenty-one were female. The mean age of the patients was 42 years(ranged 3～78 years).All patients were treated by operation.Thirty-seven patients were operated by atlantoaxial arthrodesis using wire fixation with autologous bone grafts.Nine patients of them were treated by C1-2 posterior wiring fixation and tlantoaxial facet screw fixation. Nine patients were operated by atlantoaxial arthrodesis using apofix interlaminar clamping with autologous bone grafts. Occipitocervical fusion was performed in thirty-one patients arthrodesis simple with autologous bone grafts and external fixation was used in 10 patients.CD-Cervical fixation was used in 11 patients.Cervifix fixation was used in 10 patients.Results The patients were followed up for average of three year and two months (range 6～216 months).Solid arthrodesis was obtained in the 75 patients and non-union developed in 3 cases. All non-union cases occurred with occipitocervical fusion. Conclusion Posterior fusion is recomme