| 周凤金,倪斌,谢宁,卢旭华,郭翔,郭群峰,陈金水,杨军.个体化后路寰枢椎融合内固定治疗寰枢椎不稳[J].脊柱外科杂志,2014,12(3):143-146. |
个体化后路寰枢椎融合内固定治疗寰枢椎不稳  点此下载全文 (Fulltext) |
| 周凤金 倪斌 谢宁 卢旭华 郭翔 郭群峰 陈金水 杨军 |
| 第二军医大学附属长征医院骨科, 上海, 200003;第二军医大学附属长征医院骨科, 上海, 200003;第二军医大学附属长征医院骨科, 上海, 200003;第二军医大学附属长征医院骨科, 上海, 200003;第二军医大学附属长征医院骨科, 上海, 200003;第二军医大学附属长征医院骨科, 上海, 200003;第二军医大学附属长征医院骨科, 上海, 200003;第二军医大学附属长征医院骨科, 上海, 200003 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2014.03.004 |
| 摘要点击次数: 2235 |
| 全文下载次数: 1110 |
| 摘要： |
| 目的 探讨后路寰枢椎融合治疗寰枢椎不稳的个体化方案。方法 回顾分析2006年10月～2011年6月治疗的各种原因导致的寰枢椎不稳98例，男57例，女41例。年龄4～71岁，平均37.2岁。其中，先天发育性34例，外伤性51例，类风湿性关节炎8例，强直性脊柱炎5例。所有病例均行手术复位内固定、自体髂骨移植植骨融合术，其中，采用双侧寰椎椎板钩及枢椎椎弓根螺钉内固定24例，采用双侧C1/C2关节间隙螺钉及寰椎椎板钩28例，双侧C1/C2关节间隙螺钉加改良Gallie法5例。双侧C1侧块螺钉加C2椎弓根螺钉内固定16例，双侧C1侧块螺钉加C2椎板螺钉7例，组合钉棒内固定18例。根据病情、内固定的稳定情况决定术后是否行外固定及制动时间。其中，89例存在不同程度的脊髓压迫症状。治疗前美国脊髓损伤协会（American Spinal Injury Association, ASIA）脊髓神经功能分级：B级12例，C级48例，D级29例，E级9例。 结果 随访时间12～60个月，平均32个月。所有病例枕颈部症状得到很大改善，91例获得骨性融合，7例发生延迟愈合。术后ASIA脊髓神经功能分级：B级1例，C级12例，D级32例，E级53例。手术操作无椎动脉及脊髓神经损伤病例。无内固定脱落、断裂、退钉等并发症。结论 完善的术前准备，个体化选择合适的固定融合术式，是减少手术并发症、提高疗效的有效途径。 |
| 关键词：寰枢关节 关节不稳定性 内固定器 脊柱融合术 |
| Management of atlantoaxial instability with individualized posterior atlantoaxial fixation and fusion Fulltext |
| ZHOU Feng-jin NI Bin XIE Ning LU Xu-hua GUO Xiang GUO Qun-feng CHEN Jin-shui YANG Jun |
| Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China |
| Fund Project: |
| Abstract: |
| Objective To evaluation the treatment of atlantoaxial instability by using individualized posterior atlantoaxial fixation and fusion. Methods A total of 98 patients (57 males and 41 females) with atlantoaxial instability from October 2006 to June 2011 were retrospectively analyzed, and the mean age was 37.2 years old (range, 4 to 71 years), and among them, 34 patients with congenital deformity, 51 patients had a definite history of neck injury, rheumatoid arthritis in 8 cases and ankylosing spondylitis in 5 Case. Eighty-nine patients had myelopathy with B degree in 12 cases, C degree in 48 cases and D degree in 29cases assessed by the American Spinal Injury Association (ASIA) classification. All the patients were performed by posterior atlantoaxial fusion with different fixations. Among them, there were 24 cases with bilateral atlas laminar hook and axis pedicle screws, 28 cases with bilateral atlas laminar hook and C1/C2 transarticular screws, 5 cases with C1/C2 transarticular screws plus modified Gallie technique. There were bilateral C1 lateral mass screws and C2 pedicle screws in 16 cases, and C1 lateral mass screws and C2 translaminar screws in 7 cases, and 18 cases with combined fixation. Postoperatively, the patients were managed with or without any type of orthoses according the stability of inner fixation.Results All patients were followed up for 12-60 months with an average of 32 months, and each patient was clinically and radiographically assessed. Ninety-one patients gained solid bony fusion and 7 had a delayed fusion. The devices were well placed without incident and no neurological or vascular complications occurred in these cases, No hardware failure, pseudarthrosis and instability were noted during the follow-up period. All patients had a relief of local symptoms, and neurological symptoms were substantially improved with B degree in 1 cases, C degree in 12 cases, D degree in 32 cases and E degree in 53.Conclusion Careful pre-operation examination and evaluation, and a suitable type of posterior fusion are keys to the management of atlantoaxial instability for better results and less complications. |
| Keywords:Atlanto-axial joint Joint instability Internal fixators Spinal fusion |
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