寰椎经椎板螺钉固定术在治疗寰枢椎不稳中的临床应用

[Clinical application of atlas translaminar screws fixation in treatment of atlatoaxial instability].

作者信息

Wang Guoyou, Fu Shijie, Shen Huarui, Guan Taiyuan, Xu Ping

机构信息

Department of Orthopaedics, Traditional Chinese Medicine Hospital Affiliated to Luzhou Medical College, Luzhou Sichuan 646000, PR China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Oct;27(10):1210-3.

PMID:24397133

Abstract

OBJECTIVE

To explore the effectiveness of fixation of atlas translaminar screws in the treatment of atlatoaxial instability.

METHODS

A retrospective analysis was made on the clinical data of 32 patients with atlatoaxial instability treated with atlantoaxial trans-pedicle screws between March 2007 and August 2009. Of them, 7 patients underwent atlas translaminar screws combined with axis transpedicle screws fixation because of fracture types, anatomic variation, and intraoperative reason, including 5 males and 2 females with an average age of 48.2 years (range, 35-69 years). A total of 9 translaminar screws were inserted. Injury was caused by traffic accident in 4 cases, falling from height in 2 cases, and crushing in 1 case. Two cases had simple odontoid fracture (Anderson type II), and 5 cases had odontoid fracture combined with other injuries (massa lateralis atlantis fracture in 2, atlantoaxial dislocation in 1, and Hangman fracture in 2). The interval between injury and operation was 4-9 days (mean, 6 days). The preoperative Japanese Orthopaedic Association (JOA) score was 8.29 +/- 1.60.

RESULTS

The X-ray films showed good position of the screws. Healing of incision by first intention was obtained, and no patient had injuries of the spinal cord injury, nerve root, and vertebral artery. Seven cases were followed up 9-26 months (mean, 14 months). Good bone fusion was observed at 8 months on average (range, 6-11 months). No loosening, displacement, and breakage of internal fixation, re-dislocation and instability of atlantoaxial joint, or penetrating of pedicle screw into the spinal canal and the spinal cord occurred. The JOA score was significantly improved to 15.29 +/- 1.38 at 6 months after operation (t = 32.078, P = 0.000).

CONCLUSION

Atlas translaminar screws fixation has the advantages of firm fixation, simple operating techniques, and relative safety, so it may be a remedial measure of atlatoaxial instability.

摘要

目的

探讨寰椎经椎板螺钉固定治疗寰枢椎不稳的有效性。

方法

回顾性分析2007年3月至2009年8月采用寰枢椎经椎弓根螺钉治疗的32例寰枢椎不稳患者的临床资料。其中，7例因骨折类型、解剖变异及术中原因采用寰椎经椎板螺钉联合枢椎经椎弓根螺钉固定，男5例，女2例，平均年龄48.2岁（范围35 - 69岁）。共植入9枚经椎板螺钉。损伤原因：交通事故4例，高处坠落2例，重物挤压1例。2例为单纯齿状突骨折（AndersonⅡ型），5例为齿状突骨折合并其他损伤（寰椎侧块骨折2例，寰枢椎脱位1例，绞刑架骨折2例）。受伤至手术间隔时间为4 - 9天（平均6天）。术前日本骨科协会（JOA）评分为8.29±1.60。

结果

X线片显示螺钉位置良好。切口一期愈合，无患者发生脊髓、神经根及椎动脉损伤。7例患者随访9 - 26个月（平均14个月）。平均8个月（范围6 - 11个月）观察到良好的骨融合。未发生内固定松动、移位、断裂，寰枢关节再脱位及不稳，或椎弓根螺钉穿入椎管及脊髓。术后6个月JOA评分显著提高至15.29±1.38（t = 32.078，P = 0.000）。