改良植骨方法在后路寰枢关节和枕颈融合内固定术中的应用

发布时间：2018-04-09 13:27

本文选题：上颈椎不稳　切入点：寰枢关节　出处：《中国脊柱脊髓杂志》2017年01期

【摘要】：目的:探讨改良植骨方法在寰枢关节和枕颈融合内固定术中的应用价值。方法:2011年1月~2013年1月,对32例因齿状突不连(21例)、寰椎横韧带断裂或松弛导致寰枢关节不稳(6例)以及颅底凹陷(5例)的病例,施行了后路经C1侧块或椎弓根螺钉和C2椎弓根或Magerl螺钉固定术(27例)或枕颈固定术(5例)。术中植骨时在C1和C2后弓或C2和枕骨间植入颗粒状松质骨,压实后将少许稍长的皮质骨条铺在表面,再放置明胶海绵2条,用可吸收线缠绕在两侧内置物上或缝合于两侧软组织上,形成网状结构,术后颈托固定,随访观察患者植骨融合情况。结果:所有患者均顺利完成手术。1例经口咽前路松解复位后路椎弓根螺钉内固定患者,出现术后咽后间隙感染,经积极抗感染治疗,于术后2周恢复。术中无内固定或植骨困难,术后随访未见复位N失或假关节形成。32例均获得随访,时间5个月~3年2个月,平均19.1±7.2个月,全部患者手术后3~6个月获得骨性融合。结论:在寰枢关节和枕颈融合内固定术中应用改良植骨方法,可获得满意的融合率。
[Abstract]:Objective: to investigate the application value of modified bone graft in atlantoaxial joint and occipitocervical fusion fixation.Methods: from January 2011 to January 2013, 32 cases of atlantoaxial joint instability, including 21 cases of odontoid nonunion, 6 cases of atlantoaxial joint instability caused by rupture or relaxation of transverse ligament of atlas, and 5 cases of skull base depression) were studied.27 cases were treated with posterior fixation via C1 lateral mass or pedicle screw or C2 pedicle or Magerl screw) or 5 cases with occipitocervical fixation.Results: all the patients successfully completed the operation. 1 cases of posterior pedicle screw internal fixation were treated with anterior oropharynx release reduction and posterior pedicle screw fixation. Postoperative infection of retropharyngeal space was found and recovered 2 weeks after operation.There was no internal fixation or bone graft difficulty. All the 32 cases were followed up for 5 months to 3 years and 2 months, with an average of 19.1 卤7.2 months. Bone fusion was obtained 3 ~ 6 months after operation.Conclusion: the modified bone grafting method can obtain satisfactory fusion rate in atlantoaxial joint and occipitocervical fusion internal fixation.
【作者单位】：温州医科大学附属第二医院骨科医院脊柱外科;湖州市中心医院骨科;
【分类号】：R687.3

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