摘要
目的 总结C1侧块螺钉技术在寰椎枕骨化合并枕颈不稳手术中的临床疗效.方法 回顾性分析160例2007年6月至2013年10月,在解放军总医院神经外科采用C1侧块螺钉技术固定的寰椎枕骨化合并枕颈不稳患者临床资料.对神经功能改善和植骨融合率进行随访,并对C1侧块置钉的术中注意事项进行分析.结果 160例中1例死亡,1例加重,1例稳定,155例神经功能明显改善,2例失访;157例随访12～52个月,其中147例一期复位解除了脑干和脊髓压迫,10例未复位,二期施行了前路减压术.1年随访时155例达到可靠植骨融合,2例未有明显融合.C1侧块螺钉植入点应选择在位于C1关节后表面的中点,置钉角度向头侧约0～40°,向内约0～ 20°.结论 寰椎枕骨化时C1侧块置钉技术安全可行,并能提供可靠的稳定性,经术前评估和钉道设计,能显著降低置钉风险.
Objective To summarize the clinical effect of C1 lateral mass screw fixation in patients with atlas occipitalization and occipito-cervical instability （OCI）.Methods Patients of atlas occipitalization and OCI from June 2007 to October 2013 which had been treated by C1 lateral mass fixation in our institution were retrospective analyzed.The clinical neurologic function improvement rate and bone fusion rate were investigated at follow-ups.The nuances of the C1 lateral mass insertion were summarized.Results Among the 160 patients,1 patient died,1 got worse,1 was stable,155 got recovery and 2 lost to follow-up.Among the 157 cases within 12-52 months follow-up （mean 34 months）,147 cases got reduction and release from the cervico-medullary junction compression and 10 got no effective reduction which were resumed to anterior decompression at second surgery.At one year follow-up,155 cases had solid bony fusion and 2 had no evident fusion.The entry point for C1 screw was located at the midpoint of the posterior surface of C1 facet and the screw was directed approximately between 0-40° cephalad and approximately between 0-20° medially.Conclusions C1 lateral mass screw fixation is a safe and feasible method and could provide solid stability in patients with atlas occipitalization and OCI.The risk of placement of C1 screw could be decreased to a low rate after the preoperative evaluation and trajectory design.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第35期2821-2824,共4页
National Medical Journal of China
基金
国家自然科学基金（81301274）
中国博士后基金（2014M552653）
首都临床特色项目（Z151100004015009）
关键词
寰椎枕骨化
枕颈不稳
C1侧块
螺钉固定术
Occipitalization
Occipito-cervical instability
C1 lateral mass
Screw fixation
