摘要
目的 评估椎弓根螺钉技术治疗寰枢椎骨折脱位的疗效。方法 2003年5月-2006年7月，采用寰枢椎椎弓根螺钉技术治疗寰枢椎骨折脱位37例，回顾性分析临床疗效和并发症防治。结果 37例患者采用Vertex系统固定30例，Axis系统固定7例。寰枢椎完全复位32例，大部分复位5例。寰椎侧块和枢椎椎弓根显露过程中出现静脉丛出血30例次。寰椎和枢椎各置钉74枚，寰椎后弓打孔置钉时5例5处寰椎后弓断裂和下壁破裂，改为经寰椎侧块置钉。枢椎置钉时椎动脉损伤2例（早期病例）。无切口感染、脑脊液漏和瘫痪加重患者。随访3个月-3年，平均1．4年。齿状突骨折愈合30例，畸形愈合7例；寰枢区后表面植骨融合37例，枕寰区后表面有骨痂形成2例。未见内固定松动断裂。结论 经寰枢椎椎弓根螺钉固定技术治疗寰枢椎骨折脱位，操作简便，固定牢靠，只要正确掌握适应证，术中仔细操作，大多数并发症可避免。
Objective To evaluate the effects of pedicle screw technique in treatment of atlantoaxial fractures and dislocations. Methods A total of 37 cases with atlantoaxial fractures and dislocations were treated with atlantoaxial pedicle screw technique from May 2003 to July 2006. Clinical results and complications were explored retrospectively. Results Vertex instrumentation was used in 30 cases and Axis instrumentation in seven. The dislocation in 32 cases was reduced completely and that in five reduced up to 90%. Obvious blood in 30 sets was observed when lateral mass or posterior arc of atlas and pedicle of axis were dissected and drilled. Seventy-four screws were inserted into atlas and axis but five points in five cases of posterior arc of atlas showed breakage of posterior arc of atlas and burst inferior wall of posterior arc of atlas, which were treated with Harms technique. Vertebral artery was penetrated in two cases （at early stage）. There was no infection of incision cerebral spinal fluid leakage or deterioration of spinal cord function. All cases were followed up for average 1.4 years （ range from 3 months to 3 years）. Fractures of dens were unioned completely in 30 cases and deformative union occurred in seven. Radiographs showed successful fusion in posterior surface of antoaxial region in 37 cases, but fusion of posterior surface of occepitocervical region in two. No interfixation failure was observed. Conclusion Pedicle screw technique is a convenient method with solid fixation for atlantoaxial fractures and dislocation. Most complications can be prevented under correct control of indication and careful operation.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2007年第1期16-20,共5页
Chinese Journal of Trauma
关键词
寰椎
寰枢关节
骨折固定术
内
脱位
脊柱融合术
Atlas
Atlanto-axial joint
Fracture fixation, internal
Dislocations
Spinal fusion
