中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
35期
2821-2824
,共4页
李翀%尹一恒%乔广宇%佟怀宇%余新光
李翀%尹一恆%喬廣宇%佟懷宇%餘新光
리충%윤일항%교엄우%동부우%여신광
寰椎枕骨化%枕颈不稳%C1侧块%螺钉固定术
寰椎枕骨化%枕頸不穩%C1側塊%螺釘固定術
환추침골화%침경불은%C1측괴%라정고정술
Occipitalization%Occipito-cervical instability%C1 lateral mass%Screw fixation
目的 总结C1侧块螺钉技术在寰椎枕骨化合并枕颈不稳手术中的临床疗效.方法 回顾性分析160例2007年6月至2013年10月,在解放军总医院神经外科采用C1侧块螺钉技术固定的寰椎枕骨化合并枕颈不稳患者临床资料.对神经功能改善和植骨融合率进行随访,并对C1侧块置钉的术中注意事项进行分析.结果 160例中1例死亡,1例加重,1例稳定,155例神经功能明显改善,2例失访;157例随访12～52个月,其中147例一期复位解除了脑干和脊髓压迫,10例未复位,二期施行了前路减压术.1年随访时155例达到可靠植骨融合,2例未有明显融合.C1侧块螺钉植入点应选择在位于C1关节后表面的中点,置钉角度向头侧约0～40°,向内约0～ 20°.结论 寰椎枕骨化时C1侧块置钉技术安全可行,并能提供可靠的稳定性,经术前评估和钉道设计,能显著降低置钉风险.
目的 總結C1側塊螺釘技術在寰椎枕骨化閤併枕頸不穩手術中的臨床療效.方法 迴顧性分析160例2007年6月至2013年10月,在解放軍總醫院神經外科採用C1側塊螺釘技術固定的寰椎枕骨化閤併枕頸不穩患者臨床資料.對神經功能改善和植骨融閤率進行隨訪,併對C1側塊置釘的術中註意事項進行分析.結果 160例中1例死亡,1例加重,1例穩定,155例神經功能明顯改善,2例失訪;157例隨訪12～52箇月,其中147例一期複位解除瞭腦榦和脊髓壓迫,10例未複位,二期施行瞭前路減壓術.1年隨訪時155例達到可靠植骨融閤,2例未有明顯融閤.C1側塊螺釘植入點應選擇在位于C1關節後錶麵的中點,置釘角度嚮頭側約0～40°,嚮內約0～ 20°.結論 寰椎枕骨化時C1側塊置釘技術安全可行,併能提供可靠的穩定性,經術前評估和釘道設計,能顯著降低置釘風險.
목적 총결C1측괴라정기술재환추침골화합병침경불은수술중적림상료효.방법 회고성분석160례2007년6월지2013년10월,재해방군총의원신경외과채용C1측괴라정기술고정적환추침골화합병침경불은환자림상자료.대신경공능개선화식골융합솔진행수방,병대C1측괴치정적술중주의사항진행분석.결과 160례중1례사망,1례가중,1례은정,155례신경공능명현개선,2례실방;157례수방12～52개월,기중147례일기복위해제료뇌간화척수압박,10례미복위,이기시행료전로감압술.1년수방시155례체도가고식골융합,2례미유명현융합.C1측괴라정식입점응선택재위우C1관절후표면적중점,치정각도향두측약0～40°,향내약0～ 20°.결론 환추침골화시C1측괴치정기술안전가행,병능제공가고적은정성,경술전평고화정도설계,능현저강저치정풍험.
Objective To summarize the clinical effect of C1 lateral mass screw fixation in patients with atlas occipitalization and occipito-cervical instability (OCI).Methods Patients of atlas occipitalization and OCI from June 2007 to October 2013 which had been treated by C1 lateral mass fixation in our institution were retrospective analyzed.The clinical neurologic function improvement rate and bone fusion rate were investigated at follow-ups.The nuances of the C1 lateral mass insertion were summarized.Results Among the 160 patients,1 patient died,1 got worse,1 was stable,155 got recovery and 2 lost to follow-up.Among the 157 cases within 12-52 months follow-up (mean 34 months),147 cases got reduction and release from the cervico-medullary junction compression and 10 got no effective reduction which were resumed to anterior decompression at second surgery.At one year follow-up,155 cases had solid bony fusion and 2 had no evident fusion.The entry point for C1 screw was located at the midpoint of the posterior surface of C1 facet and the screw was directed approximately between 0-40° cephalad and approximately between 0-20° medially.Conclusions C1 lateral mass screw fixation is a safe and feasible method and could provide solid stability in patients with atlas occipitalization and OCI.The risk of placement of C1 screw could be decreased to a low rate after the preoperative evaluation and trajectory design.
