后路寰枢椎椎弓根螺钉固定植骨融合治疗上颈椎不稳的疗效.docVIP

寰枢椎椎弓根螺钉固定治疗不稳郭伟韬曾荣孙欣刘思景肖启贤陈子秋 广东医学院附属医院骨科，524001 湛江市 摘 要: 目的 探讨寰枢椎椎弓根螺钉固定融合治疗寰枢椎不稳的手术方法的可行性。方法 23例外伤所致寰枢椎脱位成年患者，首先行颅骨牵引术直至寰枢椎复位，然后在气管插管全麻下实施颈后路寰枢椎椎弓根固定并自体髂骨植骨术。寰椎椎弓根钉进钉点位于枢椎侧块中线上，距寰椎后弓上缘下3.0mm，内斜15°，上斜10°；枢椎椎弓根钉进钉点位于枢椎侧块的内上象限中心点，内斜30°，上斜35°； 螺钉直径3.5mm，寰椎椎弓根螺钉长度2.6cm～3.0cm，枢椎椎弓根螺钉长度2.2cm～2.6cm。植骨面去皮质后，自体髂骨半板两块铺于植骨床植骨。结果 本组患者术中未发生椎动脉或脊髓损伤，术后随访3～15个月，神经功能获得改善；影像资料显示寰枢椎解剖关系恢复良好，螺钉位置好，术后无松动、断钉，植骨3个月椎体间达到稳定融合。结论 寰枢椎椎弓根螺钉固定植骨融合治疗上颈椎不稳是一种固定牢靠，安全可靠的方法。 关键词 椎弓根螺钉；寰枢椎不稳 Treatment of atlantoaxial instability with C1－C2 pedicle screw fixation and fusion with bone graft GUO Wei-tao, ZENG Rong, SUN Xin, LIU Si-jing, XIAO QI-xian, CHEN Zi-qiu (Department of Orthopedics, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524001,China) [Abstract] Objective To explore the feasibility of C1－C2 pedicle screw fixation and fusion with bone graft for treatment of atlantoaxial instability. Methods twenty three adult patients with atlantoaxial dislocation caused by traumas received skull traction for 3 days or up to 12 days until reset, and then were treated with C1－C2 pedicle screw fixation and fusion with bone graft under general anesthesia. The entry point of C1 pedicle screw in present technique was located on the vertical line through the central point of C2 lateral mass, and at least 3mm under the superior rim of C1 posterior arch，15° in a medial inclination and 10° in a cephalic direction. The entry point of C2 pedicle screw was located in center of the medial-superior quadrant, 30° in a medial in inclination and 30°in a cephalic direction. The screw diameter was 3.5mm, and the screw length of C1 and C2 pedicle screws were 26-30mm and 22-26mm, respectively. Result No intraoperative complications such as injuries of vertebral artery or spinal cord appeared. The group of the patients were followed up for 3～15 months, and their clinical symptoms were improved to some extent. The postoperative X ray verified not only the anatomic relationship between atlas and axis had red