發(fā)布時間：2018-04-09 13:27

  本文選題：上頸椎不穩(wěn)　切入點：寰樞關節(jié)　出處：《中國脊柱脊髓雜志》2017年01期

【摘要】：目的:探討改良植骨方法在寰樞關節(jié)和枕頸融合內固定術中的應用價值。方法:2011年1月~2013年1月,對32例因齒狀突不連(21例)、寰椎橫韌帶斷裂或松弛導致寰樞關節(jié)不穩(wěn)(6例)以及顱底凹陷(5例)的病例,施行了后路經(jīng)C1側塊或椎弓根螺釘和C2椎弓根或Magerl螺釘固定術(27例)或枕頸固定術(5例)。術中植骨時在C1和C2后弓或C2和枕骨間植入顆粒狀松質骨,壓實后將少許稍長的皮質骨條鋪在表面,再放置明膠海綿2條,用可吸收線纏繞在兩側內置物上或縫合于兩側軟組織上,形成網(wǎng)狀結構,術后頸托固定,隨訪觀察患者植骨融合情況。結果:所有患者均順利完成手術。1例經(jīng)口咽前路松解復位后路椎弓根螺釘內固定患者,出現(xiàn)術后咽后間隙感染,經(jīng)積極抗感染治療,于術后2周恢復。術中無內固定或植骨困難,術后隨訪未見復位N失或假關節(jié)形成。32例均獲得隨訪,時間5個月~3年2個月,平均19.1±7.2個月,全部患者手術后3~6個月獲得骨性融合。結論:在寰樞關節(jié)和枕頸融合內固定術中應用改良植骨方法,可獲得滿意的融合率。
[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 鹵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.
【作者單位】： 溫州醫(yī)科大學附屬第二醫(yī)院骨科醫(yī)院脊柱外科;湖州市中心醫(yī)院骨科;
【分類號】：R687.3

【參考文獻】

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本文編號：1726621