寰椎椎弓螺钉在寰枢椎不稳中的临床应用_《中国修复重建外科杂志》

作者：

汪国友 , 扶世杰 , 沈骅睿 , 关钛元 , 徐平

泸州医学院附属中医医院骨科（四川泸州，646000）;

关键词：

寰枢椎不稳寰椎椎弓螺钉内固定

DOI：

10.7507/1002-1892.20130265

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨寰椎椎弓螺钉内固定技术在寰枢椎不稳中应用的技巧与临床疗效。方法 2007年3月－2009年8月，32例因寰枢椎不稳行后路寰枢椎椎弓根螺钉固定融合的患者中，7例因骨折类型、解剖变异及术中原因改行单侧或双侧寰椎椎弓螺钉固定，共植入9枚寰椎椎弓螺钉。男5例，女2例；年龄35～69岁，平均48.2岁。致伤原因：交通事故伤4例，高处坠落伤2例，重物砸伤1例。单纯齿状突骨折2例（AndersonⅡ型）；合并寰椎侧块骨折2例，寰枢关节前脱位1例，Hangman骨折2例。受伤至手术时间4～9 d，平均6 d。术前日本骨科协会（JOA）评分为（8.29 ± 1.60）分。结果术后复查颈椎侧位及张口位X线片示螺钉位置满意。手术切口均Ⅰ期愈合；无脊髓和椎动脉损伤发生。7 例均获随访，随访时间9～26个月，平均14个月。术后X线片示植骨块均获骨性融合，融合时间6～11个月，平均8 个月。无螺钉松动、移位、断裂和寰枢椎再移位、失稳现象发生，寰椎椎管和脊髓未见侵犯。术后6个月JOA评分为（15.29 ± 1.38）分，与术前比较差异有统计学意义（t=32.078，P=0.000）。结论寰椎椎弓螺钉内固定技术固定牢固，操作简便、安全，可作为寰椎椎弓根或侧块螺钉固定失败的补救方案。

引用本文： 汪国友,扶世杰,沈骅睿,关钛元,徐平. 寰椎椎弓螺钉在寰枢椎不稳中的临床应用. 中国修复重建外科杂志, 2013, 27(10): 1210-1213. doi: 10.7507/1002-1892.20130265 复制

1.	王雷, 田纪伟, 董双海, 等. C1/2椎弓根固定技术在寰枢椎复杂骨折中的应用. 中华医学杂志, 2012, 92(11): 760-763.
2.	Resnick DK, Lapsiwale S, Toost GR. Anatomic suitability of the C1- C2 complex for pedicle screw fixation. Spine (Phila Pa 1976), 2002, 27(14): 1494-1498.
3.	谭明生, 蒋欣. 寰枢椎脱位的外科治疗原则. 中国脊柱脊髓杂志, 2012, 22(2): 103-105.
4.	Floyd T, Grob D. Translaminar screws in the atlas. Spine (Phila Pa 1976), 2000, 25(22): 2913-2915.
5.	Baaj AA, Vrionis FD. Atlantoaxial stabilization utilizing atlas translaminar fixation. J Clin Neurosci, 2010, 17(12): 1578-1580.
6.	Riesenburger RI, Jones GA, Roguski M, et al. Risk to the vertebral artery during C-2 translaminar screw placement: a thin-cut computerized tomography angiogram-based morphometric analysis. J Neurosurg Spine, 2013, 19(2): 217-221.
7.	Mammis A, Yanni DS, Thaker NG, et al. Reduction of displaced Hangman’s fracture by compression across crossed translaminar screws. J Clin Neurosci, 2012, 19(4): 582-584.
8.	Yusof MI, Shamsi SS. Translaminar screw fixation of the cervical spine in Asian population: feasibility and safety consideration based on computerized tomographic measurements. Surg Radiol Anat, 2012, 34(3): 203-207.
9.	覃炜, 权正学, 欧云生, 等. 颈后路椎弓根螺钉内固定术治疗寰枢椎不稳及脱位. 中国修复重建外科杂志, 2010, 24(2): 202-205.
10.	Ringel F, Reinke A, Stüer C, et al. Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome. Acta Neurochir (Wien), 2012, 154(2): 305-312.
11.	Jacobson ME, Khan SN, An HS. C1-C2 posterior fixation: indications, technique, and results. Orthop Clin North Am, 2012, 43(1): 11-18.
12.	Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery, 2002, 51(6): 1351-1357.
13.	Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976), 2001, 26(22): 2467-2471.
14.	Lehman RA Jr, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connect or for an unstable atlantoaxial joint. Spine (Phila Pa 1976), 2012, 12(2): 151-156.
15.	Zhou F, Ni B, Li S, et al. C2 translaminar screw as the optimal choice for atlantoaxial dislocation with C2-C3 congenital fusion. Arch Orthop Trauma Surg, 2010, 130(12): 1505-1509.
16.	金国鑫, 王欢, 李雷, 等. 寰椎后弓螺钉交叉固定的解剖学研究. 中华骨科杂志, 2012, 32(1): 65-69.
17.	何帆, 尹庆水, 马向阳. 寰椎后弓形态分类与椎弓螺钉固定的解剖学研究. 中国临床解剖学杂志, 2006, 24(3): 275-278.

1. 王雷, 田纪伟, 董双海, 等. C1/2椎弓根固定技术在寰枢椎复杂骨折中的应用. 中华医学杂志, 2012, 92(11): 760-763.
2. Resnick DK, Lapsiwale S, Toost GR. Anatomic suitability of the C1- C2 complex for pedicle screw fixation. Spine (Phila Pa 1976), 2002, 27(14): 1494-1498.
3. 谭明生, 蒋欣. 寰枢椎脱位的外科治疗原则. 中国脊柱脊髓杂志, 2012, 22(2): 103-105.
4. Floyd T, Grob D. Translaminar screws in the atlas. Spine (Phila Pa 1976), 2000, 25(22): 2913-2915.
5. Baaj AA, Vrionis FD. Atlantoaxial stabilization utilizing atlas translaminar fixation. J Clin Neurosci, 2010, 17(12): 1578-1580.
6. Riesenburger RI, Jones GA, Roguski M, et al. Risk to the vertebral artery during C-2 translaminar screw placement: a thin-cut computerized tomography angiogram-based morphometric analysis. J Neurosurg Spine, 2013, 19(2): 217-221.
7. Mammis A, Yanni DS, Thaker NG, et al. Reduction of displaced Hangman’s fracture by compression across crossed translaminar screws. J Clin Neurosci, 2012, 19(4): 582-584.
8. Yusof MI, Shamsi SS. Translaminar screw fixation of the cervical spine in Asian population: feasibility and safety consideration based on computerized tomographic measurements. Surg Radiol Anat, 2012, 34(3): 203-207.
9. 覃炜, 权正学, 欧云生, 等. 颈后路椎弓根螺钉内固定术治疗寰枢椎不稳及脱位. 中国修复重建外科杂志, 2010, 24(2): 202-205.
10. Ringel F, Reinke A, Stüer C, et al. Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome. Acta Neurochir (Wien), 2012, 154(2): 305-312.
11. Jacobson ME, Khan SN, An HS. C1-C2 posterior fixation: indications, technique, and results. Orthop Clin North Am, 2012, 43(1): 11-18.
12. Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery, 2002, 51(6): 1351-1357.
13. Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976), 2001, 26(22): 2467-2471.
14. Lehman RA Jr, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connect or for an unstable atlantoaxial joint. Spine (Phila Pa 1976), 2012, 12(2): 151-156.
15. Zhou F, Ni B, Li S, et al. C2 translaminar screw as the optimal choice for atlantoaxial dislocation with C2-C3 congenital fusion. Arch Orthop Trauma Surg, 2010, 130(12): 1505-1509.
16. 金国鑫, 王欢, 李雷, 等. 寰椎后弓螺钉交叉固定的解剖学研究. 中华骨科杂志, 2012, 32(1): 65-69.
17. 何帆, 尹庆水, 马向阳. 寰椎后弓形态分类与椎弓螺钉固定的解剖学研究. 中国临床解剖学杂志, 2006, 24(3): 275-278.

《中国修复重建外科杂志》

寰椎椎弓螺钉在寰枢椎不稳中的临床应用

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《中国修复重建外科杂志》

寰椎椎弓螺钉在寰枢椎不稳中的临床应用

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