摘要
目的 探讨对寰枢椎脱位不能完全复位的病例行后路经关节螺钉内固定术的可行性。方法 考察北京积水潭医院脊柱外科 2 0 0 1年 2月至 2 0 0 3年 1月行后路寰枢椎经关节突螺钉固定术(Magerl术 )的 19例病例 ,其中 8例未完全复位。所有病例均行双侧螺钉固定 ,观察患者术中术后的临床表现 ,行CT检查了解螺钉的位置和固定情况。结果 所有患者均完成双侧经关节螺钉固定 ,症状均有所改善 ,无神经症状加重表现。无神经血管损伤等并发症发生。 8例未完全复位病例 ,术后寰齿前间隙 (ADI)仍大于 3 5mm ;但螺钉均穿过寰枢椎侧块关节 ,位置准确 ,螺钉周围骨质充足 ,进入寰椎侧块平均 5 2 6mm ,固定确实牢靠 ,无寰枕关节受侵 ,无椎动脉损伤发生 ,其临床手术效果与完全复位者无异。结论 对寰枢椎不能完全复位的病例 ,后路寰枢椎经关节突螺钉内固定并非绝对禁忌 ,只要有充足的骨质通道容纳螺钉通过 ,Magerl术仍是安全可行的。
OBJECTIVE TO ASSESS THE FEASIBILITY OF PERFORMING THE C 1-2 TRANSARTICULAR SCREW FIXATION (MAGERL′S TECHNIQUE) FOR PATIENTS WHOSE C 1-2 DISLOCATION COULD NOT BE REDUCED COMPLETELY.METHODS NINTEEN CONSECUTIVE PATIENTS (FROM 2001 FEB. TO 2003 JAN.) UNDERWENT BILATERAL C 1-2 TRANSARTICULAR SCREW FIXATION, 8 OF WHICH HAD AN INCOMPLETELY-REDUCED ATLANTOAXIAL DISLOCATION. THE PATIENTS′ CLINICAL OUTCOMES WITHIN- AND AFTER-OPERATION WERE EVALUATED, AND THE SCREWS POSITION AND FIXATION CONDITIONS WERE STUDIED BY POSTOPERATIVE CT. RESULTS ALL THE PATIENTS′ SYMPTOMS HAD SOME IMPROVEMENT, NO SEVERE COMPLICATIONS, SUCH AS INJURY OF NERVE OR BLOOD VESSELS, ESPECIALLY THE VERTEBRAL ARTERIES, WERE ENCOUNTERED. THE SCREWS WERE PLACED PRECISELY, AND PURCHASED ENOUGH BONE SUBSTANCE. FIRM FIXATION OBTAINED, NO VERTEBRAL ARTERY LESION OCCURRED.CONCLUSION FOR THE PATIENTS WHO HAVE ATLANTOAXIAL DISLOCATION THAT COULD NOT BE REDUCED COMPLETELY, IF THERE IS ENOUGH BONE TO CONTAIN THE SCREW, PERFORMING BILATERAL TRANSARTICULAR SCREW FIXATION(MAGERL TECHNIQUE) IS STILL FEASIBLE AND SAFE.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2004年第8期649-652,共4页
National Medical Journal of China
