CAJ | 학술논문

目的：探讨后路寰椎椎板钩联合枢椎椎弓根螺钉技术治疗寰枢椎失稳的临床疗效。方法2009年12月～2012年12月，行后路寰椎椎板钩联合枢椎椎弓根螺钉固定技术的寰枢椎失稳患者，有效随访资料36例，其中男26例，女10例；年龄21～66岁，平均42．3岁；有脊髓损伤症状者28例，日本骨科学会（ Japanese Orthopaedic Association ， JOA）评分9．3±1．8；有颈枕区疼痛症状者30例，颈枕区视觉模拟量表（visual analog scale， VAS）评分3．9±1．1；36例患者颈椎障碍功能指数（neck disability index， NDI）术前27．6±8．3；有发作性眩晕症状者6例；寰枢椎脱位26例，术前均行颅骨牵引术并达到复位。结果所有患者均顺利完成手术。术中出血量为80～600 mL，平均295 mL；手术时间95～210 min，平均157 min。术后随访个6～42个月，平均21个月，35例术后6月获得融合，影像学检查可见连续骨小梁，植骨融合率97．2％。末次随访JOA评分改善至13．7±2．0，平均改善率58％；术后VAS评分1．8±0．9；NDI降低至12．9±6．4。 JOA评分、VAS评分和NDI评分术前与术后对比差异均具有统计学意义（P＜0．05）。术中未出现椎动脉、脊髓神经损伤或脑脊液漏等并发症。随访期间未发现椎板钩脱位、松动，6例有发作性眩晕患者眩晕症状消失。结论寰椎椎板钩联合枢椎椎弓根螺钉技术手术操作简单、风险低，手术时间短，有良好临床的效果，可作为治疗寰枢椎失稳的一种选择。
목적：탐토후로환추추판구연합추추추궁근라정기술치료환추추실은적림상료효。방법2009년12월～2012년12월，행후로환추추판구연합추추추궁근라정고정기술적환추추실은환자，유효수방자료36례，기중남26례，녀10례；년령21～66세，평균42．3세；유척수손상증상자28례，일본골과학회（ Japanese Orthopaedic Association ， JOA）평분9．3±1．8；유경침구동통증상자30례，경침구시각모의량표（visual analog scale， VAS）평분3．9±1．1；36례환자경추장애공능지수（neck disability index， NDI）술전27．6±8．3；유발작성현훈증상자6례；환추추탈위26례，술전균행로골견인술병체도복위。결과소유환자균순리완성수술。술중출혈량위80～600 mL，평균295 mL；수술시간95～210 min，평균157 min。술후수방개6～42개월，평균21개월，35례술후6월획득융합，영상학검사가견련속골소량，식골융합솔97．2％。말차수방JOA평분개선지13．7±2．0，평균개선솔58％；술후VAS평분1．8±0．9；NDI강저지12．9±6．4。 JOA평분、VAS평분화NDI평분술전여술후대비차이균구유통계학의의（P＜0．05）。술중미출현추동맥、척수신경손상혹뇌척액루등병발증。수방기간미발현추판구탈위、송동，6례유발작성현훈환자현훈증상소실。결론환추추판구연합추추추궁근라정기술수술조작간단、풍험저，수술시간단，유량호림상적효과，가작위치료환추추실은적일충선택。
Objective To explore the clinical effect of C 1 laminar hooks and C 2 pedicle screws fixation for atlantoaxial instability.Methods From December 2009 to December 2012, 36 patients with atlantoaxial instability were treated by C 1 laminar hooks and C 2 pedicle screws fixation .There were 26 males and 10 females aged 21 to 66 years with an average 42.3 years.There were 28 cases with symptoms of spinal cord injury , the preoperative Japanese Orthopaedic Association ( JOA) scores were 9.3 ±1.8;30 cases underwent cervical occipital pain , the visual analog scale (VAS) scores were 3.9 ±1.1;the preoperative neck disability index (NDI) scores were 27.6 ±8.3;6 cases with paroxysmal vertigo;26 cases with atlantoaxial dislocation underwent skull traction before the operation .Results The operations on all patients were successful .The average intraoperative blood loss was 295 mL (rang 80~600 mL), with an average operative time 157 min (range 95~210 min). The mean follow-up duration was 21 months (range 6~42 months), 6 months after operation, solid bony fusion were obtained in 35 cases, the rate of bone graft fusion was 97.2%.At the final follow-up, the JOA scores were 13.7 ±2.0, the VAS scores were 1.8 ±0.9, the NDI scores were 12.9 ±6.4.The differences of JOA scores , VAS scores and NDI scores between preoperative and postoperative were statistically significant .There were no vertebral artery , spinal cord injury occurred intraop-eration.During the follow-up period, no hooks loosening or displacement occurred .Conclusion Good clinical effect can be achieved by the C 1 laminar hooks and C 2 pedicle screws fixation , and it can be used for atlantoaxial instability .