寰枢椎椎弓根螺钉治疗寰枢椎不稳及脱位的临床效果-外科学(骨科)专业论文.docxVIP

重庆医 重庆医科大学硕士研究生学位论文 万方数据 万方数据 英汉缩略语名词对照 英文缩写 英文全称 中文名称 CT Computerized Tomography 计算机断层扫描 JOA (Scores) Japanese Orthopaedic Association (Scores) 日本骨科协会(评分) kg Kilogram 千克 MRI Magnetic Resonance Imaging 磁共振成像 C Computed Radiography 颈椎 mm Millimeter 毫米 h Hour 小时 ml Milliliter 毫升 1 寰枢椎椎弓根螺钉治疗寰枢椎不稳及脱位的临床效果 摘 要 背景与目的 讨论寰枢椎椎弓根螺钉治疗寰枢椎不稳及脱位的手 术指针、技术特点及临床疗效。 方法 采用寰枢椎椎弓根螺钉植入治疗 30 例寰枢椎不稳及脱位患 者，其中男 22 例，女 8 例；平均 43.5 岁，病程 1 周～ 16 年。30 例患 者均有不同程度颈部疼痛、颈部活动受限等症状；22 例伴四肢不同程 度感觉、运动障碍。4 例先天性游离齿状突、8 例齿状突陈旧性骨折及 7 例横韧带断裂的患者行后路植骨。 结果 所有患者未出现脊髓或椎动脉损伤、无断钉等严重并发症， 术后伤口无感染，X 片检查提示寰枢椎的解剖关系得到恢复。术后 3 月神经功能获得不同程度的改善;术后 6～18 个月，X 片及三维 CT 提 示：获得骨性融合；随访中，螺钉未出现松动、断裂，位置满意。 结论 在对寰枢椎不稳及脱位的治疗上，寰枢椎椎弓根螺钉技术 能有效重建寰枢椎的稳定性、提高融合率，是一种值得推广的安全可 靠的治疗手段。 关键词：寰枢椎不稳，寰枢椎脱位，椎弓根螺钉，颈后路，内固 定 2 CLINICAL EFFECT OF TREATMENT OF ATLANTOAXIAL INSTABILITY AND DISLOCATION WITH PEDICAL SCREW ABSTRACT Background and Objectives: To discussion the indication of operation, technical characateristics and clinical effect of treatment of atlantoaxial instability and dislocation with pedical screw. Methods: 30 patients with atlantoaxial instability and dislocation were treated with pedical screw, include 22 males and 8 females, with an average age of 43.5 years old, the disease course was one week to 16 years. All 30 patients had inordinately cervical pain and activity limitation, 22 patients had inordinately sensory and motor disorders of extremities. 4 patients with congenital odontoid disconnection、8 patients with old odontoid process fracture and 7 patients with transverse ligament rupture were treated with bone graft by posterior approach. Results: There were no serious complications such as spinal cord injury or vertebral artery injury and screws broken. There were no would infection. The atlantoaxial anatomy relationship was regained after X ray inspection. Neurological function had improved inordinately after 3 months 3 posteoperatively. By X ray and CT inspection, the bone infusion was gained after 6-18 months posteroperatively