CAJ | 학술논문

目的探讨寰枢椎椎弓根钉内固定融合重建上颈椎不稳的临床疗效.方法采用寰枢椎椎弓根钉内固定自体髂骨植骨治疗上颈椎不稳患者21例,其中Ⅱ型齿状突骨折13例,齿状突不连5例,横韧带损伤3例.在寰枢椎后弓间植骨融合,使寰枢椎复合体得到稳定.结果共置入84枚螺钉,术中2枚螺钉穿破寰椎左侧椎弓根外侧壁,未发生脊髓、椎动脉损伤.所有患者X线片示寰椎完全复位,枢椎齿状突骨折处复位良好.CT片示螺钉与椎动脉及脊髓位置关系良好.按JOA评分标准,优15例,良3例,可2例,差1例,优良率85.71%(18/21).17例患者获得随访,随访时间12～26(12.83±4.23)个月,均获得骨性融合,未发现钉板断裂.结论寰枢椎椎弓根螺钉结合钉板系统固定重建上颈椎不稳能显著增强寰枢椎间生物力学稳定性,植骨融合率高,该术式在寰枢椎融合术中具有较高的推广应用价值.
목적 탐토환추추추궁근정내고정융합중건상경추불은적림상료효.방법 채용환추추추궁근정내고정자체가골식골치료상경추불은환자21례,기중Ⅱ형치상돌골절13례,치상돌불련5례,횡인대손상3례.재환추추후궁간식골융합,사환추추복합체득도은정.결과 공치입84매라정,술중2매라정천파환추좌측추궁근외측벽,미발생척수、추동맥손상.소유환자X선편시환추완전복위,추추치상돌골절처복위량호.CT편시라정여추동맥급척수위치관계량호.안JOA평분표준,우15례,량3례,가2례,차1례,우량솔85.71%(18/21).17례환자획득수방,수방시간12～26(12.83±4.23)개월,균획득골성융합,미발현정판단렬.결론 환추추추궁근라정결합정판계통고정중건상경추불은능현저증강환추추간생물역학은정성,식골융합솔고,해술식재환추추융합술중구유교고적추엄응용개치.
Objective To explore the clinical effect of the atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability. Methods Using atlanto-axial pedicle screw and internal fixation system combined with autogenous iliac bone graft to treat 21 patients with upper cervical spine instability. Type Ⅱ odontoid process old fracture was 13 patients, odontoid process nonunion was 5 patients, injury of the transverse ligament was 3 patients. They were placed in 84 atlanto-axial pedicle screws, autogenous bones were placed in the posterior arch of atlas and axis to fusion, so that atlanto-axial complex got stabilized. Results The left lateral cortical bone of atlas vertebral pedicle was broken by screws in 2 patients, but the spinal cord and vertebral artery was intact. X-ray film showed the atlas and the fracture of dens of axis was completely replaced in all patients. The position of screw and vertebral artery or spinal cord was good in CT image. According to JOA score standard, 15 cases of all were excellent, 3 cases were good,2 cases were common,1 case was bad, and the rate of excellent and good was 85.71%(18/21).Seventeen cases were followed up for 12-26 (12.83 ± 4.23) months, all patients had acquired bone fusion and found no screw and plate fracture. Conclusions Atlanto-axial pedicle screw combined with screw-plate system fixation to treat upper cervical spine instability, can significantly enhance the biomechanical stability of the atlanto-axial interbody, bone grafting fusion rate is higher, the application value of the atlanto-axialfusion is higher.