枢椎椎弓根钉板结合对侧椎板钉棒固定在寰枢椎及枕颈固定中的应用

摘要

目的：探讨后路单侧枢椎椎弓根钉板系统结合对侧枢椎椎板钉棒系统在寰枢关节及枕颈固定中的临床疗效。方法后路单侧椎弓根钉板系统结合对侧枢椎椎板钉棒系统寰枢椎固定及枕颈固定11例，新鲜Ⅱ型齿突骨折5例，陈旧性齿突骨折3例，寰椎枕骨化畸形2例，寰枢椎不稳1例。单侧椎弓根发育狭小者6例，单侧椎动脉优势型2例，一侧椎动脉高跨2例，寰椎枕骨化畸形寰枢关节脱位行钉板系统固定失效后再次手术1例。寰枢椎固定9例，枕颈固定2例，1例难复型寰枢关节脱位行经口咽前路松解＋后路复位内固定融合术，术后内固定失效行翻修手术。全部患者行后路寰枢或枕颈固定植骨融合术。比较术前、术后 JOA 评分变化，术后随访 X 线片及 CT，观察寰枢椎复位及融合情况。结果所有患者均得到随访，随访时间6～32个月，平均16个月。全组患者无一例发生脊髓或椎动脉损伤，寰枢椎得到解剖复位，临床症状得到不同程度改善。术后 JOA 评分13～16分，平均14．9分，术前、术后 JOA 评分改善率为76％～92％，平均83％，术后半年复查 CT 显示均获得骨性融合，未见寰枢椎失稳或复位丢失征象，固定螺钉位置良好。结论单侧枢椎椎弓根钉板系统结合对侧枢椎椎板钉棒系统行寰枢关节及枕颈固定临床疗效可靠，但缺少临床对比研究。%Objective To discuss the clinical effect and safety of the unilateral C2 pedicle screw-plate(C2PSP)combined with contralateral C2 laminar screw-rod(C2LSR)for atlanto-axial joint and occipital cervical fixation.Methods 11 patients were treated by internal fixation with pedicle screw plate system combined with contralateral C2 laminar screw rod system.The cause of atlantoaxial instability was fresh type Ⅱ odontoid fracture in 5 patients,old odontoid fracture in 3 patients,occipitalization mal-formation in 2 patients,atlantoaxial instability in 2 patients.6 patients had small pedicle of the vertebral arch,2 patients had a high-riding vertebral artery(VA),2 patients had an asymmetrical VA,1 patient re-ceived a revision operation.9 patients performed C1-2 fixation,2 patients performed occipito-cervical fixa-tion.1 patient of irreducible atlantoaxial dislocation also performed anterior atlantoaxial joint release before posterior Fixation.All patients performed bone grafting to achieve a further occipito-cervical fusion or at-lantoaxial fusion.Before and after the operation,the neurologic function was scored according JOA scale. The X-ray and CT-scan also performed at regular intervals to evaluate cervical alignment and the fusion. Results All cases were complete reposition without vertebral artery,spinal cord or never root injuried.All patients were followed up for 6-32 months ( mean 16 months ),clinical symptom were improved visibly. The mean postoperative JOA scores was 14.9(13-16).The postoperative JOA score improvement rate was 76%-92%,and its mean value was 83%.All patients achieved bone fusion approved by CT scan after six months of operation.The reduction maintained well and the internal fixation was well positioned.Conclu-sion It will be an effective and safe way to achieve atlantoaxial fusion by posterior unilateral C2 pedicle screwing combined with contralateral C2 laminar screwing,but this study had not including clinical com-parative study.