摘要
目的 报告上颈椎疾患的后路内固定方法。方法根据不同的病损采用不同的后路手术治疗上颈椎疾病27例，其中采用后路Mawrl联合Gallie固定技术治疗齿状突AndersonⅡ型5例，Apofix治疗齿状突AndersonⅡ型3例和横韧带断裂2例，AxisC1～2侧块固定治疗AndersonⅢ型2例和齿状突发育不良2例，AxisC1～4和C2～3侧块固定分别治疗C2～3椎体爆裂性骨折1例和HangmanⅡ、Ⅲ型骨折4例；枕颈固定技术治疗寰椎Jefferson骨折2例、颅骨凹陷Chair畸形2例和AndersonⅡ型合并寰椎后弓骨折1例；C2椎弓根螺钉固定HangmanⅠ型骨折3例。结果术中损伤椎动脉1例，直接拧紧螺钉止血，术后无脑缺血表现；术中损伤硬脊膜2例，术后出现一过性脑脊液漏，经治疗后愈合；无一例脊髓损伤及死亡。随访3～48个月，平均13．7个月，27例后路固定位置良好，均融合，未见内固定松动及断裂。结论后路坚强固定保证了上颈椎的稳定性，有利于局部植骨融合和患者早期锻炼。
Objective To investigate the intemal fixation and fusion technique with posterior approach in treatment of diseases of upper cervical spine. Methods Twenty-seven patients with diseases of upper cervical spine underwent the operations with the posterior approach. Magerl method combined with Gallie fixation technique was used in 5 patients with Anderson Type Ⅱ odontoid process fracture while Apofix method was employed in 3 patients with Anderson Type Ⅱ fracture and in 2 patients with rupture of transverse ligaments. Two patients with Anderson Type Ⅲ fracture and two patients with dysplasia of odontoid process were treated with Axis plate internal fixation of the lateral masses of C1 and Ca. One patient with burst fractures of Ca and C3, and 4 patients with Hangman Type Ⅱ , fractures were treated with Axis plate internal fixation of the lateral masses of C1-4 and Ca-3 respectively. Two patients with Jefferson fracture of atlas, 2 patients with Chair congenital malformation and 1 patient with Anderson Type ll combined with the fracture posterior arch of atlas were treated with occipital-cervical fixation technique. Three patients were treated with pediele screw fixation of Ca. Resnlts： The vertebral artery was injuried in one patient. The screw was tightened up to stop bleeding immediately. No cerebral ischemia occurred postoperatively. The spinal dura mater was injuried during operation with postoperative transient cerebrospinal fluid fistula that was cured by treatment. Neither injury of spinal cord nor death occurred. Followed-up period was from 3 to 48 months with the average of 13.7 months. The position of posterior fixation was fine and fusion occurred in all of the 27 patients without loosening and fracture. Conclusion The posterior solid immobilization guarantees the stability of upper cervical spine and benefits the local graft fusion and the early functional exercises of the patients.
出处
《中国骨与关节损伤杂志》
2006年第2期83-85,共3页
Chinese Journal of Bone and Joint Injury
关键词
上颈椎疾患
内固定
融合
后路
Diseases of upper cervical spine
Internal fixation
Fusion
Posterior approach
