摘要
目的:探讨后路寰枢椎内固定治疗上颈椎不稳的影像学结果以及临床疗效。方法:对2005年9月至2011年1月对采用后路寰枢椎内固定技术治疗的155例上颈椎不稳患者进行回顾性分析,其中男68例,女87例;年龄6～75岁,平均45.6岁;新鲜齿状突骨折53例(AdersonⅡC型),游离齿突30例,齿状突陈旧性骨折20例,不稳定寰椎骨折18例,寰枢椎旋转脱位12例,类风湿性关节炎寰枢椎脱位11例,颅底凹陷症11例。影像学评价包括寰椎椎弓根螺钉的置钉情况、术后骨折愈合及植骨融合情况;临床疗效采用疼痛视觉模拟评分(VAS)和日本骨科协会评分(JOA)对颈枕区疼痛缓解进行评价。结果:150例患者行寰椎椎弓根螺钉固定置钉300枚,5例患者寰椎行挂钩固定。术后CT显示寰椎椎弓根螺钉理想置钉275枚(91.7%),可接受置钉14枚(4.7%),不可接受置钉11枚(3.6%)。155例患者获得随访,时间16～40个月,平均25.4个月,新鲜骨折患者均骨折愈合,140例植骨融合患者达到骨性融合。术前VAS、JOA评分分别为(7.2±1.1)、(7.3±2.4)分,末次随访时分别改善至(3.2±1.1)、(13.3±2.4)分。结论:后路寰枢椎内固定治疗上颈椎不稳能有效恢复颈椎生理曲度,并提供足够的机械稳定,获得优良的临床疗效;对于年轻有较高活动要求的患者可选择后路固定非融合技术,并避免取髂骨植骨。
Objective：To explore radiographic results and clinical effects of posterior atlanto axial vertebra internal fixation in treating instability of occipitocervical. Methods：The clinical data of 155 patients with instability of occipitocervical treated by posterior atlanto axial vertebra internal fixation were respectively analyzed from September 2005 to January 2011. There were 68 males and 87 females,ranging in age from 6 to 75 years old with an average of 45.6 years old. Of them ,53 cases were fresh odontoid fractures（Aderson typeⅡC）,30 cases were os odontoideum,20 cases were old odontoid fractures,18 cases were unstable atlas fractures,12 cases were atlanto axial rotatory dislocation,11 cases were atlanto axial dislocation after rheumatoid arthritis,and 11 cases were basilar invagination. Radiographic results were evaluated in terms of atlas pedicle screw fixation,bone healing and bone graft fusion. Clinical effect evaluation included relief of pain in the occipital-cervical region by VAS score and JOA score. Results：Totally 300 screws were set through atlas pedicle screw fixation in 150 patients. Five patients receivde hook fixation. Postoperative CT showed ideal nailing were 275 （91.7% ）,acceptable nailing were 14 （4.7%） and unacceptable nailing were 11（3.6%）. All patients were followed up,and the duration ranged from 16 to 40 months with an average of 25.4 months. The fresh fractures healed and 140 cases got bone graft fusion. Preoperative VAS and JOA score were respectively improved from （ 7.2±1.1 ）,（ 7.3±2.4 ） to （3.2±1.1）,（ 13.3±2.4） at the latest follow-up. Conclusion： Posterior atlanto axial vertebra internal fixation in treating instability of occipitocervical can effectively recover physiological curvature of cervical,provide mechanical stability,and obtain good clinical effect. For the young patients who require further activity,posterior fixation and non fusion technology is a good choose,which can avoid bone graft.
出处
《中国骨伤》
CAS
2013年第6期493-496,共4页
China Journal of Orthopaedics and Traumatology
关键词
寰椎
枢椎
关节不稳定性
骨折固定术
内
颈椎
Atlas
Axis
Joint instability
Fracture fixation
internal
Cervical vertebrae
