后路VERTEX椎弓根钉内固定治疗外伤性寰枢椎不稳的疗效分析.doc

后路VERTEX椎弓根钉内固定治疗外伤性寰枢椎不稳的疗效分析 温州医科大学附属温岭医院 温岭第一人民医院脊柱外科(317500) 李宏杰 张文斌 莫挺挺 方春养 【摘要】 目的：探讨后路椎弓根钉内固定治疗外伤性寰枢椎不稳的临床疗效。方法：回顾性研究2008年1月～2013年4月收治的32例外伤性寰枢椎不稳患者，其中不稳定寰椎骨折6例，齿状突Ⅱ型骨折9例，陈旧性齿状突骨折并寰枢椎不稳4例，寰椎横韧带损伤 6例，Hangman 骨折7例。均有枕颈部疼痛，颈部僵硬，活动受限，术前JOA评分为10.2±2.6。所有患者均采用后路椎弓根钉内固定治疗。结果：本组32例患者均顺利完成手术，术后复查X线片及CT，除1例寰椎及2例枢椎椎弓根钉穿破椎弓根外侧壁，其余螺钉位置正常，随访时未发现螺钉松动、移位、断裂及寰枢椎再移位现象，术后6月骨折愈合，植骨融合。无脊髓损伤加重症状，无头晕、头痛等椎动脉缺血症状，术后患者颈部疼痛均自诉明显好转。术后6月JOA评分为15.1±1.8 (P﹤0.05)。结论：后路椎弓根钉内固定是治疗外伤性寰枢椎不稳的一种有效手术方法。 【关键词】 寰枢椎；失稳；椎弓根钉；内固定 Clinical effect of posterior vertex pedicle screw fixation for treatment of instability of atlantoaxial vertebra. /LI Hongjie, ZHANG Wenbing, MO Tingting, et al. Department of Spine Surgery ,Wenling hospital affiliated to Wenzhou medical university, Zhejiang, 317500, P.R.China. 【Abstract】 Objective To investigate the effectiveness of posterior vertex pedicle screw fixation for treatment of instability of atlantoaxial vertebra. Methods 32 patients with instability of atlantoaxial vertebra from January 2008 to April 2013 undergoing the surgical treatment by posterior vertex pedicle screw internal fixation were reviewed retrospectively. Of these cases, 6 cases were unable atlas fractures, 9 cases were odontoid fractures(type Ⅱ), 4 cases were old odontoid fractures, 6 cases were fragmentation of ligament transversum atlas and 7 cases were Hangman fractures. All cases complained of cervical pain and stiffness. The JOA score was 10.2?.6 before operation. fResults All 32 cases were operated successfully. The radiologic follow-up data indicated the position of pedicle screw were fine，except one screw of atlas and two of axis penetrating into the paries lateralis of vertebral pedicle. And all cases got bony fusion,no instrument looseness or breakage was found. All cases felt pain relief without clinical exacerbation of spinal cord injury or dizziness, headache because of vertebral artery ischemia. The JOA score was 15.1±1.8 (P﹤0.05). Conclusion Posterior vertex pedicle screw int