| 创伤性寰枢椎不稳的手术治疗策略 |
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Received:June 03, 2006
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| 作者 | Author | 单位 | Unit | E-Mail |
| 罗为民 |
LUO Wei-min |
长沙市中心医院骨三科,湖南长沙410007 |
Orthopaedics of Changsha Center Hospital,Changsha 410007,Hunan,China |
czlwm570@hotmai.lcom |
| 熊波 |
XIONG Bo |
郴州市第一人民医院脊柱外科 |
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| 汤敬武 |
TANG Jing-wu |
长沙市中心医院骨三科,湖南长沙410007 |
Orthopaedics of Changsha Center Hospital,Changsha 410007,Hunan,China |
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| 陈先礼 |
CHEN Xian-li |
长沙市中心医院骨三科,湖南长沙410007 |
Orthopaedics of Changsha Center Hospital,Changsha 410007,Hunan,China |
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| 期刊信息：《中国骨伤》2006年19卷，第11期，第648-651页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的:探讨创伤性寰枢椎不稳的手术治疗方式,指导选择安全稳定可靠的术式。
方法:29例创伤性寰枢椎不稳的病例,男22例,女7例;年龄16~52岁,平均32岁。齿状突骨折19例中,Ander-sonⅡ型16例,浅Ⅲ型3例;另外,寰椎横韧带损伤6例,陈旧性寰枢关节旋转性脱位1例,HangmanⅠ型骨折合并齿状突骨折1例,寰椎骨折合并寰椎横韧带损伤1例,齿状突骨折合并单侧枢椎上关节骨折1例。根据不同的损伤部位选择相应的手术
方法:,其中前路单枚齿状突螺钉固定10例,后路Magerl螺钉固定6例,Magerl联合Gallie5例,Magerl联合Brooks双钛缆固定2例,Magerl联合Apofix椎板夹固定2例,寰枢椎侧块钉板固定4例。19例后路手术中11例采用C1、C2椎板间颗粒状植骨,8例未行植骨融合。
结果:随访时间6个月~5年,平均18个月。术中未出现椎动脉或脊髓损伤等严重并发症,无内固定断裂。1例术后出现舌下神经麻痹,2周后缓解。10例前路齿状突螺钉固定中9例获得骨性愈合,1例齿状突螺钉固定发生松动,枢椎前方皮质破裂,取出齿状突螺钉,改行后路Magerl+Gallie法固定,获得骨性融合。19例后路手术中8例未做融合的病例获骨折愈合,其中6例行内固定取出,基本恢复头颈旋转功能,其余11例均获得骨性融合。
结论:新鲜齿状突骨折不适于前路齿状突螺钉固定时,后路C1、C2椎弓根钉板暂时固定,可保留寰枢旋转功能。寰枢椎椎弓根钉板系统在生物力学稳定及适应证方面有一定的优势。 |
| [关键词]:寰枢关节 关节不稳定性 骨折固定术,内 |
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| Tactics of surgery treatment for traumatic instability of atlanto-axial joint |
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Abstract:
Objective:To Discuss on surgical treatment for traumatic instability of atlanto-axial joint.
Methods:Twenty-nine patients with traumatic instability of atlanto-axial joint included 22 male and 7 female,ranging from age 16 to 52 years with an average of 32 years.Among 19 cases with fracture of the odontoid process,there were 16 cases of type Ⅱ fracture of Anderson and 3 cases of fleet type Ⅲ fracture,6 cases of disrupted transverse ligament,1 case of relapse rolling luxation of atlanto-axial arthrosis ,1 case of type Ⅰ of Hangman’s fracture accompanying with odontoid fracture,1 case of atlanto-axial fracture accompanying with trauma of transverse ligament of atlanto-axial,1 case of odontoid fracture accompanying with upper arthrosis fracture of unilateral atlanto-axial.Diverse operation treatments were adopted according to the relevant traumatic parts,including 10 cases with fixation by single front screw of dentate protuberance,6 cases with fixation by rear Magerl screw,5 cases with Magerl-Gallie,2 cases with fixtion by Magerl emerging Broooks double Titanium cable,2 cases with fixation by Magerl emerging Apofix board,4 cases with fixation by side nailed board of atlanto-axial.Eleven of 19 cases of rear part operation adopted C1 to C2 vertebral interbody granule bone transplant,8 cases bone fusion without bone transplant.
Results:The patients were followed up for an average of 18 months （range 6 to 60 months）.There were no case of serious syndrome such as trauma of artery of vertebra or trauma of spinal cord,neither the case of rupture of internal fixation.There was one case of anaesthetization of hypoglossal after operation which was relieved two weeks later on.Nine of 10 cases of fixation by front screw of dentate protuberance achieved concrescence of bone.There happened flexible of screw in one case of fixation by screw of dentate protuberance,where front cortex of atlanto-axial is broken,but bone fusion was finally made by rear fixation of Magerl+Gallie instead of screw of dentate protuberance.Eight cases which were not treated by fusion in 19 cases of rear operation were finally obtain concrescence of fracture.In 6 cases of which internal fixation were brought out and the function of rotary movement of the patients were almost renewed.The rest 11 cases finally obtained fusion.
Conclusion:Doctors should prudently select the surgery method on the basis of the traumatic part of the patient,causes of atlanto-axial instability and expericence of one’s own.Atlanto-axial vertebral arc root screw plant system takes dominance to certain extent in aspects of stability of biology mechanics and adaptation.Try best to maintain physiological function of upper neck at expense of little trauma. |
| KEYWORDS:Atlanto-axial joint Joint instability Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 罗为民,熊波,汤敬武,陈先礼.创伤性寰枢椎不稳的手术治疗策略[J].中国骨伤,2006,19(11):648~651 |
| 英文格式: | LUO Wei-min,XIONG Bo,TANG Jing-wu,CHEN Xian-li.Tactics of surgery treatment for traumatic instability of atlanto-axial joint[J].zhongguo gu shang / China J Orthop Trauma ,2006,19(11):648~651 |
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