寰枢椎椎弓根螺钉固定治疗创伤性寰枢椎不稳.doc

寰枢椎椎弓根螺钉固定治疗创伤性寰枢椎不稳 郭伟韬，祝葆华，曾荣，孙欣，刘思景，肖启贤，陈子秋 （524001广东湛江，广东医学院附属医院骨科） [摘要] 目的 探讨寰枢椎椎弓根螺钉固定复位植骨融合治疗创伤性寰枢椎不稳的手术方法的可行性。方法 选取23例外伤所致寰枢椎脱位成年患者，男性16例，女性7例，年龄17～64岁，平均36.8岁；其中横韧带断裂5例，按照Anderson Ⅰ型齿状突骨折1例，Anderson Ⅱ骨折11例，Anderson Ⅲ 型骨折6例，均合并脊髓功能障碍。首先行颅骨牵引术力争寰枢椎复位，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3.5 mm，寰椎椎弓根螺钉长度2.6～3.0 cm，枢椎椎弓根螺钉长度2.2～2.6 cm。植骨面去皮质后，两块自体髂骨半板松质骨面铺于植骨床植骨。结果 本组患者术中未发生椎动脉或脊髓损伤，术后随访8～25 [关键词] 椎弓根螺钉；寰枢椎不稳；融合 Treatment of atlantoaxial instability with C1—－C2 pedicle screw fixation and fusion with bone autografting: report of 23 cases Guo Wei-tao, Zhu Baohua, Zeng Rong, Sun Xin, Liu Si-jing, Xiao QI-xian, Chen Zi-qiu (Department of Orthopedics, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong Province, 524001, China) [Abstract] Objective To explore the feasibility of C1－C2 pedicle screw fixation and fusion with bone autografting for treatment of atlantoaxial instability. Methods tTwenty -three adult patients, 16 males and 7 females with a mean age of 36.8 (ranging from 17 t0 64), with atlantoaxial dislocation in 2 h to 7 d (mean 18 h) caused byafter traumas were hospitalized in our department from January 2008 to December 2009. There were 5 cases having fracture, and 1 case of Anderson = 1 \* ROMAN I, 11 cases of Anderson II fracture, and 6 cases of Anderson III fracture. All cases were accompanied with spinal cord dysfunction. After skull traction was carried outreceived skull traction for 3 days or up to 12 days until reset, and then these cases were treated with C1－C2 pedicle screw fixation and fusion with bone autograft 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 3 mm 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