Qin Wei, Quan Zhengxue, Ou Yunsheng, Jiang Dianming, Liu Yang, Tang Ke
Department of Orthopedics, First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Feb;24(2):202-5.
To explore the surgical feasibility and clinical outcome of transpedicle screw fixation in treatment of atlantoaxial instability and dislocation.
From January 2007 to June 2009, 16 patients with atlantoaxial instability and dislocation were treated with transpedicle screw fixation. There were 13 males and 3 females, with a mean age of 42 years (range, 24-61 years). The transpedicle screw fixation was employed in 5 patients with old odontoid fracture (4 of Anderson type II and 1 of type III), in 4 patients with fresh odontoid fracture, in 4 patients with traumatic disruption of transverse atlantal ligament, and in 3 patients with congenital odontoid disconnection for atlantoaxial instability. All patients had symptoms of cervical pain and limiting of cervical motion, 10 patients complicated by dyscinesia and hypoesthesia of extremities. The Japanese Orthopaedic Association (JOA) score before operation was from 5 to 13, with an average of 8.5. The image examination showed atlantoaxial instability or dislocation in all patients. Granulated autogenous ilium (20-30 g) was placed onto the surface of the posterior arches of both atlas and axis in some patients with old fracture of odontoid process or disruption of transverse atlantal ligament.
The mean operative time and bleeding amount were 1.6 hours (1.2-2.5 hours) and 100 mL (50-200 mL), respectively. All the incision healed by first intension. All patients were followed up for 3-18 months, with an average of 11.5 months. The JOA score 3 months after operation was from 12 to 17, with an average of 14.2. All screws were successfully placed in atlas and axis. No postoperative complications such as vertebral artery injury, dural rupture, exacerbation of neurological symptoms, wound infection, and broken screws were observed in 16 cases. Postoperative radiograph and CT showed that only one screw penetrated into vertebral canal, but there was no neurological symptoms. Bony fusion was observed after 6 to 18 months of operation, and atlantoaxial rotational function in all patients restored satisfactorily, but axial rotation was partially lost.
Transpedicle screw fixation in upper cervical spine for treatment of atlantoaxial instability and dislocation is safe and reliable.
探讨经椎弓根螺钉固定治疗寰枢椎不稳及脱位的手术可行性及临床疗效。
2007年1月至2009年6月，对16例寰枢椎不稳及脱位患者采用经椎弓根螺钉固定治疗。其中男性13例，女性3例，平均年龄42岁（范围24 - 61岁）。5例陈旧性齿状突骨折（AndersonⅡ型4例，Ⅲ型1例）、4例新鲜齿状突骨折、4例寰椎横韧带外伤性断裂及3例先天性齿状突分离致寰枢椎不稳患者采用经椎弓根螺钉固定。所有患者均有颈部疼痛及颈部活动受限症状，10例合并肢体运动障碍及感觉减退。术前日本骨科学会（JOA）评分为5 - 13分，平均8.5分。影像学检查均显示寰枢椎不稳或脱位。部分陈旧性齿状突骨折或寰椎横韧带断裂患者在寰椎和枢椎后弓表面植入自体颗粒髂骨（20 - 30 g）。
平均手术时间及出血量分别为1.6小时（1.2 - 2.5小时）和100 mL（50 - 200 mL）。所有切口均一期愈合。所有患者随访3 - 18个月，平均11.5个月。术后3个月JOA评分为12 - 17分，平均14.2分。所有螺钉均成功植入寰椎和枢椎。16例患者均未出现椎动脉损伤、硬脊膜破裂、神经症状加重、伤口感染及螺钉断裂等术后并发症。术后X线片及CT显示仅1枚螺钉穿入椎管，但无神经症状。术后6至18个月观察到骨融合，所有患者寰枢椎旋转功能恢复满意，但轴向旋转部分丧失。
上颈椎经椎弓根螺钉固定治疗寰枢椎不稳及脱位安全可靠。
