CAJ | 학술논문

目的探讨经关节螺钉内固定治疗寰枢椎不稳的疗效.方法自2000年5月至2011年10月使用经关节螺钉内固定治疗寰枢椎不稳患者56例,男43例,女13例；年龄17 ～71岁,平均38岁.1例患者脊髓神经完全损伤,29例无脊髓神经损伤症状,26例伴有脊髓神经不全损伤,按美国脊髓损伤协会(ASIA)脊髓神经功能障碍分级:C级10例,D级16例；ASIA评分50～90分,平均(78.5±9.3)分.其中后路经关节螺钉内固定32例,在寰椎后弓与枢椎椎板表面植骨.前路经关节螺钉内固定24例,在寰椎前弓下缘和齿状突基底部之间植骨.结果 1例颈脊髓神经完全损伤患者前路经寰枢关节螺钉内固定,术后1个月死于肺部感染.其他55例患者术后获6个月至9年(平均16个月)随访,手术切口均Ⅰ期愈合.1例齿状突Ⅱ型粉碎性骨折并寰枢关节脱位患者寰枢椎前路经关节螺钉内固定并植骨,齿状突未骨性愈合,但寰枢关节纤维连接无不稳定表现.其余植骨患者均获骨性融合.26例脊髓神经不全损伤患者术后ASIA分级(C级3例,D级10例,E级13例)和评分[(92.5±8.6)分]均较术前明显改善,差异有统计学意义(P＜0.05).结论寰枢椎经关节螺钉内固定,操作简便、费用低廉、疗效可靠,可以作为治疗寰枢椎不稳患者的有效手段.
목적 탐토경관절라정내고정치료환추추불은적료효.방법 자2000년5월지2011년10월사용경관절라정내고정치료환추추불은환자56례,남43례,녀13례；년령17 ～71세,평균38세.1례환자척수신경완전손상,29례무척수신경손상증상,26례반유척수신경불전손상,안미국척수손상협회(ASIA)척수신경공능장애분급:C급10례,D급16례；ASIA평분50～90분,평균(78.5±9.3)분.기중후로경관절라정내고정32례,재환추후궁여추추추판표면식골.전로경관절라정내고정24례,재환추전궁하연화치상돌기저부지간식골.결과 1례경척수신경완전손상환자전로경환추관절라정내고정,술후1개월사우폐부감염.기타55례환자술후획6개월지9년(평균16개월)수방,수술절구균Ⅰ기유합.1례치상돌Ⅱ형분쇄성골절병환추관절탈위환자환추추전로경관절라정내고정병식골,치상돌미골성유합,단환추관절섬유련접무불은정표현.기여식골환자균획골성융합.26례척수신경불전손상환자술후ASIA분급(C급3례,D급10례,E급13례)화평분[(92.5±8.6)분]균교술전명현개선,차이유통계학의의(P＜0.05).결론 환추추경관절라정내고정,조작간편、비용저렴、료효가고,가이작위치료환추추불은환자적유효수단.
Objective To evaluate transarticular screw fixation in the treatment of atlantoaxial instability.Methods From May 2000 to October 2011,56 patients with atlantoaxial instability were treated with transarticular screw fixation in our department.They were 43 men and 13 women,aged from 17 to 71 years (average,38 years).One patient had complete trauma at the cervical cord,29 patients presented with no symptom of defects of the cervical cord,and 26 patients were complicated with partial injury to the cervical cord.Of the 26 patients with incomplete neural injury,10 were rated as grade C and 16 as grade D according to the American Spinal Injury Association (ASIA) grading system.Their ASIA scores ranged from 50 to 90 points,averaging 78.5 ± 9.3 points.For 24 patients,anterior C1-2 transarticular screw fixation was conducted together with bone grafting between the lower edge of the anterior arch of atlas and odontoid base.For another 32 patients,posterior C1-2 transarticular screw fixation was conducted together with bone grafting between the posterior arch of atlas and the surface of axis lamina.Results One patient with complete trauma at the cervical cord died of pulmonary infection one month after anterior C1-2 transarticular screw fixation.Other 55 patients were followed up from 6 months to 9 years,averaging 16 months.All surgical incisions got primary healing.One patient with comminuted odontoid Ⅱ fracture and atlantoaxial dislocation failed to achieve bony union after anterior C1-2 transarticular screw fixation and bone grafting,but still obtained stability of atlantoaxial joint.The other cases all had bone fusion after bone grafting.The 26 patients with incomplete neural injury obtained significant improvements in both ASIA grading (3 grade C,10 grade D and 13 grade E) and ASIA scoring (92.5 ± 8.6 points) (P ＜ 0.05).Conclusion The technique of atlantoaxial transarticular screw fixation should be recommended for the treatment of atlantoaxial instability,because it is simple,cheap,reliable,and effective.