摘要
目的报告C2椎弓根螺钉结合C1侧块或枕骨螺钉用于颅颈交界区后路内固定的解剖研究及临床应用结果。方法福尔马林固定的头颈标本4个，根据解剖标志分别植入C2椎弓根及C1侧块螺钉，然后行CT扫描及重建，观察螺钉位置。2004年5月至2007年1月，利用C2椎弓根-C1侧块／枕骨螺钉内固定9例病人，男4例，女5例，年龄12～68岁，平均38岁；各种原因引起的C1-C2半脱位6例，因颅底凹陷经口腔齿状突切除后1例，斜坡脊索瘤经口腔切除手术前2例；采用C2椎弓根-C1侧块螺钉技术4例，C2椎弓根-枕骨螺钉技术5例，手术后均行CT扫描观察螺钉位置。结果手术中直接显露C2椎弓根内上缘，并以此确立进钉方向，在椎弓根峡部后缘确定进钉点，可保证C2椎弓根螺钉的安全植入；直接显露C1侧块后正中确立进钉点，可避免螺钉植入过程中的椎动脉损伤。9例病人中，手术后CT复查有2例病人两颗螺钉穿破骨皮质，但未造成血管及神经的压迫，其余螺钉位置均较好；随访4—32个月，1例临床症状较术前无变化，其余8例均改善。结论C2椎弓根-C1侧块／枕骨螺钉技术可安全有效地用于颅颈交界区内固定。
Objective To report the results of anatomical study and clinical application of C2 pedicle screws combined with C1 lateral mass or occipital screws used for posterior craniovertebral junction internal fixation. Methods Four cadaver specimens of head and neck fixed by formalin were used for study of C2 pedicle and C1 lateral mass screw insertion, afterwards, CT scan was performed for evaluation of the position of the screws. From May 2004 to January 2007, C2 pedical-C1 lateral mass/occipital screws internal fixation was applied in 9 patients, including 4 male and 5 female, their age ranged from 12 to 68 years old. Fixation was performed for C1-C2 sublaxion due to various reasons in 6 patients, after transoral odontoidectomy due to basilar invagination in 1 patient, before transoral removal of clival chordoma in 2 patients. Among them, C2 pedical-C1 lateral mass screws fixation technique was used in 4 patients, C2 pedical-occipital screws fixation technique in 5. Results It was necessary to directly expose the superointerior edge of the C2 pedical, in order to localize the entry point of the screw in the posterior part of the isthmus and to justify the screw direction; direct exposure of the posterior midline of the C1 lateral mass helps localize the screw entry point and avoid injury of the vertebral artery. Among 9 patients, postoperative CT demonstrated 2 screws breakthrough of the cortical bone in 2 patients, without neural or vascular compression or injury; in the other patients, all the screws were appropriately positioned. Follow-up ranged from 4 to 32 months, clinical improvement was found in 8 patients; only in one patient, the symptoms did not change postoperatively. Conclusion C2 pedical-C1 lateral mass/occipital screws can be used for posterior craniovertebral junction internal fixation safely and effectively.
出处
《中华神经外科杂志》
CSCD
北大核心
2008年第10期725-727,共3页
Chinese Journal of Neurosurgery
关键词
寰椎
枢椎
枕骨
螺钉
内固定
Atlas
Axis
Occipital bone
Screws
Internal fixation
