论文部分内容阅读
[目的]探讨经寰枢椎椎弓根钉板固定融合治疗上颈椎伤病的临床疗效.[方法]回顾2000年3月～2007年9月,徒手对50例上颈椎伤病患者进行后路经寰枢椎椎弓根钉板系统复位内固定,置入200枚寰楸椎椎弓根钉,在寰椎后弓及枢椎椎板间植骨融合,使寰枢椎复合体得到稳定.其中男36例,女14例;年龄20～65岁,平均41.52岁.Ⅱ型齿状突陈旧性骨折23例,齿状突不连12例,横韧带损伤15例.[结果]4例术后出现枕大神经痛,经对症治疗1个月后痊愈;2例螺钉穿破寰椎左侧椎弓根外侧壁,未发现脊髓、椎动脉损伤.48例获得随访,随访时间25～60个月,平均27.56个月,均获得骨性融合,未发现钉板断裂.所有患者X线片示寰椎完全复位,枢稚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34例,良13例,可2例,差1例;优良率94.00%.[结论]寰枢椎椎弓根螺钉结合钉板系统固定治疗上颈椎伤病,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.“,”[Objective]To investigate the effect of atlanto-axial pedicle screw plate and fusion in treatment of upper cervical injuries.[Methods]Fifty-six cases of upper cervical spine injuries were treated with atlanto-axial pedicle screw plate and internal fixation,with total 200 screws,from March 2000 to September 2007.There were 36 males and 14 females,with an average age of 41.52 years(ranged,20-65 years).There were 23 cases of type Ⅱ odontoid process fracture,12 cases of odontoid process nonunion,15 cases of transverse ligament injury.[Results]Greater occipital nerve pain occurred in 4 cases postoperatively and fully recovered after treatment 1 month later.The lateral cortical bone was penetrated by screws in 2 cases,without spinal cord or vertebral artery injury.Forty-eight cases were followed up for an average of 27.56 months(ranged,25～60 months).Bone fusion was achieved in all cases,without plate or screw broken.X-ray showed complete replacement of atlas and odontoid process of axis fracture.CT showed good position relation between screw and vertebral artery or spinal cord.According to JOA classification,excellent result was achieved in 34 cases,good in 13 cases,fair in 2 cases,poor in 1 case,with the good-to-excellent rate of 94.00%.[Conclusion]Atlanto-axial pedicle screw combined with plate fixation system is effective in treatment of upper cervical injuries.It can significantly improve the biomechanical stability of atlantoaxial joint,with high bone graft fusion rate.