枕颈固定技术在上颈椎不稳的应用.docVIP

枕颈固定技术在上颈椎不稳的应用 马维虎 徐荣明，孙韶华 摘要 目的 探讨枕颈固定技术在上颈椎不稳的应用效果。方法 自2001年10月至2004年2月采用AXIS系统治疗上颈椎不稳21例，其中齿状突骨折不愈合7例，C1、2联合性骨折（Jeffson 骨折联合Hangman骨折并C1-2不稳）6例，先天性畸形4例，Jeffson 骨折合并枕颈不稳4例。内固定采用三种方法，第一种采用C2椎弓根固定的枕颈融合，7例，第二种采用C2椎弓根和C3侧块固定的枕颈融合，8例，第三种采用C2、3椎弓根固定的枕颈融合，6例。结果 21例病人随访6~32月，平均19月。有2例切口感染，经清创后愈合。术前脊髓压迫症5例，术后均有不同程度的改善。1例Charis畸形患者经内引流并枕颈融合术后1月因脑积液漏致植骨块脱落行二次手术对植骨块行螺钉固定。所有病例除1例植骨块吸收假关节形成外，其余均在3~6月内植骨融合。未见内固定松动和断裂等并发症。无脊髓、神经根和椎动脉损伤等并发症。结论 使用枢椎椎弓根螺钉行枕颈融合手术是一种固定可靠，短节段固定，临床效果理想，是枕颈融合可选用的内固定方法之一。 关键词 上颈椎，枕颈融合；内固定 Application of the posterior occipitocervical fixation technique in occipitocervical instability Ma Weihu Xu Rongming Sun Shaohua. (Department of Orthopaedics,No 6th People’s Hospital,Ningbo,Zhejiang,China 315040) Abstract Objective: to observe the clinical effect of Application of the posterior occipitocervical fixation technique in occipitocervical instability. Methods: From October 2001 to February 2004,21 patients with occipito-cervical instability or atlanto-axial instability underwent occipital-cervical fusion using AXISinternal fixation system with autologous bone grafts which included 7 cases of old atlantoaxial fractures and /with dislocation,6 cases of combination fracture of Jeffson fractures and Hangman fractures with atlanto-axial instability,4 cases of Jeffson fractures with occipitocervical instability,4 cases with complex occipitalcervical deformity. There were 3 type fixation methods: ⑴occipitocervical fixation of C2pedicle screws fixation in 7 cases,⑵occipitocervical fixation of C2pedicle screws and C3 lateal mass screws in 8 cases,⑶occipitocervical fixation of C2 and C3 pedicle screws fixation in 6cases. Results 21 patients were observed clinically and radiographically at at an average of 19 months after surgery. 20 patients got solid fusion radiologically and one patient had no fusion.Of the 5cases patients with neurologic deficits, all of them had a significant improvement from their myelopathy.No patient had a worse result after surgery.There