寰枢椎不稳及脱位的颈后路手术.doc

寰枢椎不稳及脱位的颈后路手术治疗 肖鲁伟 童培建 季卫锋 厉驹 马镇川 浙江省中医院 310006 【摘要】目的 对寰枢椎不稳及脱位的颈后路手术治疗进行回顾。方法 对34例寰枢椎不稳及脱位的患者进行颈后路手术治疗，其中男19例，女15例；年龄5～72岁，平均46岁。其中齿突骨折（新鲜骨折、陈旧骨折、骨不连）19例，寰椎横韧带断裂6例，枕颈部发育畸形5例，寰椎椎弓陈旧性骨折4例。所有病例均行颈后路手术，包括寰枢椎融合术22例，其中Apofix椎板钩内固定16例，联合钢缆(cable)及钢丝内固定共6例。枕颈融合术12例，其中单纯植骨融合4例，辅以CD-Cervical内固定5例，Cervifix内固定3例。结果 术后随访6个月～5年 ,颈椎侧位Ｘ线片检查 , 33例获骨性愈合。不愈合1例。结论 对于由寰枢椎骨折、畸形、横韧带断裂等引起的寰枢椎不稳及脱位，应早期进行后路融合术。解剖复位、稳定的内固定是手术成功的关键。 【关键词】寰枢关节；关节不稳定性；关节固定术 Posterior surgical approach for operation of atlantoaxial instability and dislocation XIAO Lu-Wei Li Ju TONG Pei-jian JI Wei-feng Ma Zheng-chuan Zhejiang provicial hospital of TCM HangZhou 310006 【Abstract】 Objective To investigate the results of surgical treatment of atlantoaxial instability and dislocation.through posterior approach. Methods 34 patients with atlantoaxial instability and dislocation were used for this collective review. There were 19 males and 15 females. The mean age of the patients was 46 years(range, 5 - 72years). the patients included 19 with unstable odontoid fractures, 6 with a disrapted transverse ligament, 5 with congenital occipitocervical abnormalities, 4 with old Jefferson fractures. All patients were treated by operation. 22 patients were operated upon by atlantoaxial arthrodesis. 6 were treated by wire fixation or cable fixation. 16 were operated on by atlantoaxial arthrodesis using Apofix interlam-inar clamping with autologous bone grafts. Occipitocervical fusion was performed in 12 patients, arthrodesis simple with autologous bone grafts and external fixation was done in 4 patients. CD -Cervical fixation was used in 5 patients. Cervifix fixation was used in 3 patients. Results The patients were followed up for 6 -60 months .Solid arthrodesis was obtained in 33 patients and non-union in 1 cases. Conclusion Posterior fusion is recommended for atlantoaxial instability due to traumatic fracture or ligament disruption, tumor, inflammatory, skeletal dysplasias, congenital abnormalities. It