后路寰枢椎椎弓根螺钉固定治疗创伤性寰枢椎不稳的临床研究.PDF

　 军 杂 2015年9月1 日　第40卷　第9期 754 解放 医学 志　 论　著 后路寰枢椎椎弓根螺钉固定治疗创伤性寰枢椎不稳的临床 研究 王正雷，孙鹏，张文进，李阳，刘建辉，郭宁，孔军，范文宪，宫明，齐琦，于洋 [摘要]　目的　探讨颈椎后路寰枢椎椎弓根螺钉固定技术治疗创伤性寰枢椎不稳的临床疗效。方法　回顾性分析 2009年9月－2013年3月在解放军211 医院采用颈椎后路寰枢椎椎弓根螺钉固定技术治疗的17例创伤性寰枢椎不稳患者的 临床资料，其中男12例，女5例，年龄19 ～63岁，平均42岁，寰枢椎骨折脱位8例，寰椎横韧带断裂2例，齿状突骨折 7例，术前神经功能JOA 评分为5.0 ～14.0分，平均11.2分。术前均行颈椎X 线片、CT 、MRI 等影像学检查。结果　术中 无椎动脉、脊髓和神经根损伤发生。17例患者均完全复位，术后第1天在颈托保护下下床活动。术后随访6~36个月， 平均21个月，临床症状明显改善。术后6个月时复查影像学检查显示所有螺钉位置良好，植骨愈合良好，无内置物松 动、断裂。术后12个月JOA 评分为11.0~17.0分，平均15.5分，与术前比较差异有统计学意义(P 0.05) 。结论　采用寰枢 椎椎弓根螺钉固定技术治疗创伤性寰枢椎不稳安全可靠，疗效满意。 [关键词]　寰枢椎不稳；椎弓根螺钉；矫形外科手术 [中图分类号]　R687.37　　　　[文献标志码]　A　　　　[文章编号]　0577-7402(2015)09-0754-04 [DOI]　10.11855/j.issn.0577-7402.2015.09.14 Posterior atlantoaxial transpedicle screw fixation for traumatic atlatoaxial instability WANG Zheng-lei, SUN Peng, ZHNG Wen-jin, LI Yang, LIU Jian-hui, GUO Ning, KONG Jun, FAN Wen-Xian, GONG Ming, QI Qi, Yu Yang Second Department of Orthopedics, 211 Hospital of PLA, Harbin 150080, China [Abstract]　Objective　To explore the clinical efficacy of posterior atlantoaxial pedicle screw fixation for traumatic atlantoaxial instability. Methods　From September 2009 to March 2013, 17 patients with atlantoaxial instability received posterior atlantoaxial pedicle screw fixation. There were 12 males and 5 females, with a mean age of 42 years old (ranged from 19 to 63 years old). Transpedicle screw fixation was employed in 8 patients with atlantoaxial fracture and dislocation, in 2 with traumatic disruption of transverse atlantal ligament, and in 7 with odontoid fracture. The Japanese Orthopaedic Asso ciation ( JOA) score before operation was from 5 to 14, with a mean of 11.2. Preoperative CT, MRI and radiographs, as well as intraoperative screw placement and bone graft were administered in all the patients. Results　In all the patients, complete reduction was achieved without injury to the ve