寰椎椎弓螺釘在寰樞椎不穩中的臨床應用_《中國修復重建外科雜志》

作者：

汪國友 , 扶世杰 , 沈驊睿 , 關鈦元 , 徐平

瀘州醫學院附屬中醫醫院骨科（四川瀘州，646000）;

關鍵詞：

寰樞椎不穩寰椎椎弓螺釘內固定

DOI：

10.7507/1002-1892.20130265

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目的探討寰椎椎弓螺釘內固定技術在寰樞椎不穩中應用的技巧與臨床療效。方法 2007年3月－2009年8月，32例因寰樞椎不穩行后路寰樞椎椎弓根螺釘固定融合的患者中，7例因骨折類型、解剖變異及術中原因改行單側或雙側寰椎椎弓螺釘固定，共植入9枚寰椎椎弓螺釘。男5例，女2例；年齡35～69歲，平均48.2歲。致傷原因：交通事故傷4例，高處墜落傷2例，重物砸傷1例。單純齒狀突骨折2例（AndersonⅡ型）；合并寰椎側塊骨折2例，寰樞關節前脫位1例，Hangman骨折2例。受傷至手術時間4～9 d，平均6 d。術前日本骨科協會（JOA）評分為（8.29 ± 1.60）分。結果術后復查頸椎側位及張口位X線片示螺釘位置滿意。手術切口均Ⅰ期愈合；無脊髓和椎動脈損傷發生。7 例均獲隨訪，隨訪時間9～26個月，平均14個月。術后X線片示植骨塊均獲骨性融合，融合時間6～11個月，平均8 個月。無螺釘松動、移位、斷裂和寰樞椎再移位、失穩現象發生，寰椎椎管和脊髓未見侵犯。術后6個月JOA評分為（15.29 ± 1.38）分，與術前比較差異有統計學意義（t=32.078，P=0.000）。結論寰椎椎弓螺釘內固定技術固定牢固，操作簡便、安全，可作為寰椎椎弓根或側塊螺釘固定失敗的補救方案。

引用本文： 汪國友,扶世杰,沈驊睿,關鈦元,徐平. 寰椎椎弓螺釘在寰樞椎不穩中的臨床應用. 中國修復重建外科雜志, 2013, 27(10): 1210-1213. doi: 10.7507/1002-1892.20130265 復制

1.	王雷, 田紀偉, 董雙海, 等. C1/2椎弓根固定技術在寰樞椎復雜骨折中的應用. 中華醫學雜志, 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.	譚明生, 蔣欣. 寰樞椎脫位的外科治療原則. 中國脊柱脊髓雜志, 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.	覃煒, 權正學, 歐云生, 等. 頸后路椎弓根螺釘內固定術治療寰樞椎不穩及脫位. 中國修復重建外科雜志, 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.	金國鑫, 王歡, 李雷, 等. 寰椎后弓螺釘交叉固定的解剖學研究. 中華骨科雜志, 2012, 32(1): 65-69.
17.	何帆, 尹慶水, 馬向陽. 寰椎后弓形態分類與椎弓螺釘固定的解剖學研究. 中國臨床解剖學雜志, 2006, 24(3): 275-278.

1. 王雷, 田紀偉, 董雙海, 等. C1/2椎弓根固定技術在寰樞椎復雜骨折中的應用. 中華醫學雜志, 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. 譚明生, 蔣欣. 寰樞椎脫位的外科治療原則. 中國脊柱脊髓雜志, 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. 覃煒, 權正學, 歐云生, 等. 頸后路椎弓根螺釘內固定術治療寰樞椎不穩及脫位. 中國修復重建外科雜志, 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. 金國鑫, 王歡, 李雷, 等. 寰椎后弓螺釘交叉固定的解剖學研究. 中華骨科雜志, 2012, 32(1): 65-69.
17. 何帆, 尹慶水, 馬向陽. 寰椎后弓形態分類與椎弓螺釘固定的解剖學研究. 中國臨床解剖學雜志, 2006, 24(3): 275-278.

《中國修復重建外科雜志》

寰椎椎弓螺釘在寰樞椎不穩中的臨床應用

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《中國修復重建外科雜志》

寰椎椎弓螺釘在寰樞椎不穩中的臨床應用

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