摘要
寰枢椎侧块关节融合器广泛应用于颅颈交界区疾病的手术治疗,其优势在于维持复位和改善力线、提高骨融合率、恢复和维持颅椎区力学稳定性。椎动脉损伤为常见并发症,术前血管造影和颈椎CT对评估椎动脉与寰枢椎的解剖关系具有重要临床价值。术中侧块间操作时需充分暴露椎动脉或采用导航进行椎动脉孔定位,可以有效降低损伤椎动脉的风险。双极电凝和水下凝固技术也是控制术中出血的有效方案,此外,融合器移位也是常见并发症。在操作中应轻柔撑开寰枢关节面,保持皮质骨完整,尽可能选用边缘圆钝的铰刀和尺寸合适的撑开器撑开,以避免植入融合器后出现关节面塌陷和融合器下沉。在撑开椎间隙和植入融合器的操作过程中使用神经电生理监测,并选择合适高度的融合器可有效降低脊髓损伤的风险。
Atlantoaxial lateral mass fusion cages have been widely applied in the surgical treatment of craniovertebral junction diseases.The advantages include maintaining reduction and improving alignment,enhancing the bone fusion rate,and restoring and preserving the biomechanical stability of the craniovertebral junction.Vertebral artery injury is a common complication,and preoperative angiography and cervical computed tomography hold important clinical value for evaluating the anatomical relationship between the vertebral artery and the atlas and axis.Sufficient exposure of the vertebral artery or navigation-guided vertebral foramen localization during intraoperative lateral mass manipulation can effectively reduce the risk of vertebral artery injury.Bipolar electrocoagulation and underwater coagulation techniques are also effective strategies for controlling intraoperative bleeding.In addition,cage subsidence is another common complication.Gentle distraction of the atlantoaxial joint surfaces should be performed during the operation to preserve the integrity of cortical bone;reamers with blunt edges and distractors of appropriate sizes should be used as much as possible for distraction to avoid joint surface collapse and cage subsidence after cage implantation.Intraoperative neuroelectrophysiological monitoring during intervertebral space distraction and cage implantation,combined with the selection of cages with appropriate heights,can effectively reduce the risk of spinal cord injury.
作者
姚星辰
王圣林
Yao Xingchen;Wang Shenglin(Department of Spinal Surgery,Peking University Third Hospital,Beijing 100191,China)
出处
《中华骨科杂志》
北大核心
2026年第3期211-216,共6页
Chinese Journal of Orthopaedics
关键词
寰枢关节
内固定器
脊柱融合
Atlanto-axial joint
Fixation,internal
Spinal fusion
