3D显微镜下椎弓钉固定治疗寰枢椎骨折脱位△

3D microscope assisted posterior pedicle screw internal fixation for atlantoaxial fracture and dislocation

摘要:

[目的]介绍 3D 显微镜下椎弓钉固定治疗寰枢椎骨折脱位的手术技术和初步临床效果。[方法]2018 年 1 月—2020 年 6 月本科采用 3D 显微镜下椎弓钉固定治疗寰枢椎骨折脱位患者 11 例。术前经 PACS 系统测量椎弓钉置钉长度与角度，术中行颈后路显露寰枢椎后方结构，在 3D 显微镜下对术野精准止血，利用磨钻对寰枢椎进钉点开口，置入椎弓钉并连接两侧钛棒，根据透视情况，适当提拉复位，于寰枢椎后方植入自体骨颗粒。[结果]11 例患者均顺利完成手术。共置入椎弓钉 44 枚， 其中 0 级与Ⅰ级置钉 42 枚，置钉优良率 95.45%。所有患者均获随访，随访时间 12~24 个月，平均(16.36±4.72)个月，VAS 评分由术前的(6.36±1.63)分，显著降低至术后 1 年的(1.27±1.10)分，差异有统计学意义(P＜0.05)；JOA 评分由术前的(11.91± 2.84)分，显著提高至术后 1 年的(15.55±1.51)分，差异有统计学意义(P＜0.05)。[结论]3D 显微镜下椎弓钉固定治疗寰枢椎骨折脱位疗效确切，术中置钉精准，手术安全性高。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of 3D microscope assisted pedicle screw fixation for atlantoaxial fracture and dislocation. [Methods] From January 2018 to June 2020, 11 patients received 3D microscope assisted pedicle screw fixation for atlantoaxial fracture and dislocation. The length and angle of pedicular screw placement were measured by PACS system before operation. After posterior atlantoaxial structures were exposed through posterior cervical approach, the operation field was ac- curately hemostatic under 3D microscope. The entry point of atlantoaxial screw was opened by grinding drill, and the pedicle screw was placed and connected with titanium rods on both sides, which were adjusted to reduce the atlantoaxial alignment under fluoroscopy. Finally, bone autografts in granule were implanted behind the atlantoaxial vertebrae. [Results] All patients had operation completed successfully with 44 pedicle screws placed totally, and 42 screws inserted in 0 and I grades with accuracy of 95.45%. The VAS score decreased signifi- cantly from (6.36±1.63) to (1.27±1.10) (P＜0.05) , whereas the JOA score increased significantly from (11.91±2.84) preoperatively to (15.55± 1.51) at 1 year after operation. [Conclusion] This 3D microscopic assisted pedicle screw fixation is an effective treatment for atlantoaxial fracture and dislocation, with improving accuracy of intraoperative screw placement and operation safety.