后路融合固定术治疗创伤性寰枢椎不稳与脱位(论文资料).docVIP

后路融合固定术治疗创伤性寰枢椎不稳与脱位 　　作者：欧云生，蒋电明，权正学，安洪 　　摘要：目的 探讨后路融合固定术治疗创伤性寰枢椎不稳与脱位的临床疗效及手术方式的选择。方法 对23例创伤性寰枢椎不稳与脱位的后路手术治疗进行分析。10例寰枢椎不稳及7例可复性寰枢椎脱位，行寰枢椎内固定、植骨融合术;6例不可复性寰枢椎脱位，行寰椎后弓切除减压、枕颈融合术。结果 1例可复性寰枢椎脱位于术后1周死亡;1例术后脱位复发，症状未改善。其余病例随访5个月～5年，枕颈部症状减轻或消失，神经系统症状有不同程度改善;寰枢椎或枕颈部植骨于3～6个月骨性融合;无内固定物松动、断裂。结论 后路融合固定术是治疗创伤性寰枢椎不稳与脱位的有效方法。术前应仔细分析创伤性寰枢椎不稳或脱位的特点。 　　关键词：寰枢关节;脱位;颈椎损伤;内固定 　　Treatment of posterior arthrodesis with internal fixation for the atlantoaxial instability or dislocation caused by injury 　　OU Yunsheng,JIANG Dianming,QUAN Zhengxue，et al. 　　(Department of Orthopaedics,First Affiliated Hospital of Chongqing University of Medical Sciences,Chongqing 400016,China) 　　Abstract：Objective To investigate the results of posterior arthrodesis for treatment of the atlantoaxial instability or dislocation caused by injury,and discuss operation method.Methods Ten cases of the atlantoaxial instability and 7 cases of the reducible atlantoaxial dislocation were treated by arthrodesis with internal fixation and bone grafting posteriorly at atlantoaxial position.Six cases of the irreducible atlantoaxial dislocation were decompressed by resecting the atlantal arch and internal fixation and bone grafting between occiput and atlas.Results One reducible dislocation case died,and redislocation occurred in 1 reducible dislocation case,the others were followed up for an average 26 months (ranged 5 months to 5 years).All 22 cases undergoing fusion achieved bony union in 36 months after surgery.The symptom of local ache and nervous system recovered in different extends.Conclusion It is an effective method to treat the atlantoaxial instability or dislocation by posterior arthrodesis,and it is important to be familiar with clinical features before surgery. 　　Key words：atlantoaxial joint;dislocation;cervical vertebra injury;internal fixation 　　创伤性寰枢椎不稳与脱位是常见的上颈椎损伤，易致高位颈脊髓压迫症，潜在危险性大，需积极的外科手术解除脊髓的压迫，恢复和重建寰枢椎的稳定性[1]。上颈椎融合固定术是创伤性寰枢椎不稳与脱位的重要治疗手段，其中后入路枕颈或寰枢椎内固定融合术是临床最常用的治疗方法。我院于1998