后路改良经关节螺钉内固定术治疗寰枢椎不稳定_临床医学论文.docVIP

后路改良经关节螺钉内固定术治疗寰枢椎不稳定_临床医学论文 后路改良经关节螺钉内固定术治疗寰枢椎不稳定_临床医学论文 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]To explore the techniques and effect of atlantoaxial instability with posterior transarticular screw fixation. [Method]A prospective clinical analysis was performed for the results of the modified posterior C1、2 transarticular screw fixation, in which the middle site of lower margin in the axial inferior articular process was used as the screw entry point in the procedure. Twenty cases of atlantoaxial instability underwent the modified C1、2 stabilization with morselized autograft from September 2001 to September 2006.There were 15 males and 5 females, averaged 32.2 years (range 17 to 49 years).Of them, 4 cases suffered from fresh injuries, 14 from old trauma, 1 from congenital deformity, and 1 from intraspinal tumor.Postoperative indexes including the reduction extent of vertebral body, internal fixation, bone fusion, clinical symptoms and their complication were observed periodically.[Result]Bilateral screw fixation was used alone in 17 cases, with Gallie interspinous wiring for added stability in 3. Anatomical reduction of the atlantoaxial joints was achieved in19 cases, while rotational dislocation was restored to a great extent in 1. Fixation of all the internal devices was very well in the group. All cases were followed up from 16 to 64 months (21 months on average). C1、2 bony fusion was obtained in postoperative 2 to 3 months, clinical symptoms relieved and no complications occurred.[Conclusion]The modified posterior transarticular screw fixation using new screw entry site is recommended as an effective treatment for C1、2 instab