Lu Yan, Wang Jian, Zheng Wenjie, Liu Jie, Huang Bo
Department of Orthopaedics, the 187th Hospital of Chinese PLA, Haikou, Hainan, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Jul;26(7):769-72.
To investigate the clinical results and complications of minimally invasive anterior transarticular screw fixation and fusion for atlantoaxial instability.
Between May 2007 and December 2010, 13 patients with atlantoaxial instability were treated with minimally invasive anterior transarticular screw fixation and fusion under endoscope. There were 11 males and 2 females, aged 17-61 years (mean, 41.3 years). The time between injury and operation was 5-14 days (mean, 7.4 days). All cases included 6 patients with Jefferson fracture, 5 with odontoid fracture, and 2 with os odontoideum. According to Frankel classification of nerve functions, 2 cases were rated as grade D and 11 cases as graed E. The operation time, intra-operative blood loss, radiation exposure time, and complications were recorded and analyzed. The stability was observed by X-ray films. The clinical outcome was assessed using the Frankel scale, and the fusion rates were determined by CT scan three-dimensional reconstruction at last follow-up.
The mean operation time was 124 minutes (range, 95-156 minutes); the mean intra-operative blood loss was 65 mL (range, 30-105 mL); and the mean radiation exposure time was 41 seconds (range, 30-64 seconds). Thirteen patients were followed up 12-47 months (mean, 25.9 months). No blood vessel and nerve injuries or internal fixator failure occurred. The bone fusion time was 6 months, and the dynamic cervical radiography showed no instability occured. At last follow-up, the neurological function was grade E in all patients. The fusion rate was 84.6% (11/13). No continuous bone bridge was seen in the joint space of 2 patients, but they achieved stability.
Minimally invasive anterior transarticular screw fixation and fusion is a safe and effective procedure for treatment of atlantoaxial instability.
探讨微创前路经关节螺钉固定融合术治疗寰枢椎不稳的临床疗效及并发症。
2007年5月至2010年12月，13例寰枢椎不稳患者在内镜下接受微创前路经关节螺钉固定融合术治疗。其中男性11例，女性2例，年龄17 - 61岁（平均41.3岁）。受伤至手术时间为5 - 14天（平均7.4天）。所有病例中，Jefferson骨折6例，齿状突骨折5例，齿突骨2例。根据Frankel神经功能分级，D级2例，E级11例。记录并分析手术时间、术中出血量、X线暴露时间及并发症。通过X线片观察稳定性。采用Frankel分级评估临床疗效，末次随访时通过CT三维重建确定融合率。
平均手术时间为124分钟（范围95 - 156分钟）；平均术中出血量为65毫升（范围30 - 105毫升）；平均X线暴露时间为41秒（范围30 - 64秒）。13例患者随访12 - 47个月（平均25.9个月）。未发生血管和神经损伤或内固定失败。骨融合时间为6个月，颈椎动态X线片显示无不稳发生。末次随访时，所有患者神经功能均为E级。融合率为84.6%（11/13）。2例患者关节间隙未见连续骨桥，但达到了稳定。
微创前路经关节螺钉固定融合术是治疗寰枢椎不稳的一种安全有效的方法。
