寰枢椎不稳的前后路内固定技术的治疗进展(1)
【摘要】 寰枢椎不稳是由炎症、创伤、先天性疾病、肿瘤或退变引起的脊柱生物力学异常改变，可能导致患者四肢瘫痪，甚至危及生命，其治疗一直是脊柱外科领域的难点之一，常常需要手术固定。随着现代外科诊疗水平的日益提高，寰枢椎脱位的诊疗技术也随之不断发展，出现了多种手术内固定方式。经前路内固定手术方法有前路经寰枢关节螺钉内固定术(ATS)，前路钢板内固定术目前主要有经口咽寰枢椎钢板(Harms钢板)、前路寰枢关节锁定钢板(SAALP)、经口咽前路寰枢椎复位钢板系统(TARP)、经口咽前路重建钢板(TORP)。经后路技术有Gallie技术和Brooks钢丝或钛缆内固定技术，Halifax或Apofix椎板夹内固定技术，Magerl经寰枢椎关节突螺钉联合后路钢丝或钛缆法内固定技术，C1～C2侧块和椎弓根螺钉钉棒或钉板内固定技术。寰枢椎不稳的其他手术方式主要有微创手术、数字骨科技术、导向器技术以及维持寰枢椎活动性的动态固定技术。但以上几种技术还在研究实验中或初步应用于临床，需进一步研究评价。本文就寰枢椎不稳手术治疗的进展作一综述。
【关键词】 寰枢椎不稳； 前路； 后路； 治疗进展
, 百拇医药
【Abstract】 Instability of the atlanto-axial complexly caused by inflammatory， trauma， congenital neoplast or degenerative disorders. It was one of considerable challenges to the veterinary surgery and could lead to quadriplegia and even life-threatening. With the increasing level of modern surgical clinics， diagnosis and treatment for instability of the atlanto-axial achieved great progress. A variety of internal fixation methods were invented. Anterior fixation methods prior to passing atlantoaxial screw fixation (ATS)， anterior plate fixation Currently there transoral atlantoaxial plate (Harms plate)， anterior atlantoaxial joint locking plate (SAALP)， transoral atlantoaxial reduction plate system (TARP)， transoral anterior reconstruction plate (TORP). Posterior technology include Gallie technology and Brooks steel or titanium cable fixation techniques， Halifax or Apofix lamina clip fixation techniques， within Magerl by atlantoaxial facet screw steel or titanium cable joint posterior fixation method， C1- lateral mass and C2 pedicle screw or nail plate screw-rod fixation techniques. Atlantoaxial instability in other major surgical include minimally invasive surgery， orthopedics dynamic fixation techniques of digital technology-oriented technology and to maintain atlantoaxial activity. But over several techniques used in experiments or preliminary clinical evaluation of the need for further study are still studying. In this paper， the progress of atlantoaxial instability surgery on reviewed.
, 百拇医药
【Key words】 Atlantoaxial instability； Anterior； Posterior； Treatment progress
First-author’s address： Nanhua University Affiliated the First People’s Hospital of Chenzhou， Chenzhou 423000， China
doi：10.3969/j.issn.1674-4985.2015.07.050
随着工农业及交通建筑业的迅速发展，寰枢椎病变损伤导致不稳的患者日渐增多。作为枕颈移行部位，寰椎在颈椎中具有最大的活动度，约占颈椎旋转活动的50%。其形态结构复杂，具有与其他颈椎不同的解剖学特征，功能特殊，邻近颈髓、椎动脉和颈神经等重要结构，此区的畸形与病损常导致严重的临床后果；又因部位深在及生物力学性质独特，最不稳定，其病损的诊断和治疗相对复杂和棘手，一直是脊柱外科的难点之一。保守治疗不愈合率高达50%～80%[1]，齿状突骨折不稳未经治疗或治疗不当造成的不愈合率为41.7%～72.0%[2]，故手术治疗已成为首选的治疗方法，随着医学诊疗技术不断改进提高，寰枢椎不稳的外科治疗不断发展进步[3]，各种内固定方法均有其优缺点。本文就寰枢椎不稳前后路内固定技术的进展予以综述。, 百拇医药(黄克敏 熊波 刘社庭)
【关键词】 寰枢椎不稳； 前路； 后路； 治疗进展
, 百拇医药
【Abstract】 Instability of the atlanto-axial complexly caused by inflammatory， trauma， congenital neoplast or degenerative disorders. It was one of considerable challenges to the veterinary surgery and could lead to quadriplegia and even life-threatening. With the increasing level of modern surgical clinics， diagnosis and treatment for instability of the atlanto-axial achieved great progress. A variety of internal fixation methods were invented. Anterior fixation methods prior to passing atlantoaxial screw fixation (ATS)， anterior plate fixation Currently there transoral atlantoaxial plate (Harms plate)， anterior atlantoaxial joint locking plate (SAALP)， transoral atlantoaxial reduction plate system (TARP)， transoral anterior reconstruction plate (TORP). Posterior technology include Gallie technology and Brooks steel or titanium cable fixation techniques， Halifax or Apofix lamina clip fixation techniques， within Magerl by atlantoaxial facet screw steel or titanium cable joint posterior fixation method， C1- lateral mass and C2 pedicle screw or nail plate screw-rod fixation techniques. Atlantoaxial instability in other major surgical include minimally invasive surgery， orthopedics dynamic fixation techniques of digital technology-oriented technology and to maintain atlantoaxial activity. But over several techniques used in experiments or preliminary clinical evaluation of the need for further study are still studying. In this paper， the progress of atlantoaxial instability surgery on reviewed.
, 百拇医药
【Key words】 Atlantoaxial instability； Anterior； Posterior； Treatment progress
First-author’s address： Nanhua University Affiliated the First People’s Hospital of Chenzhou， Chenzhou 423000， China
doi：10.3969/j.issn.1674-4985.2015.07.050
随着工农业及交通建筑业的迅速发展，寰枢椎病变损伤导致不稳的患者日渐增多。作为枕颈移行部位，寰椎在颈椎中具有最大的活动度，约占颈椎旋转活动的50%。其形态结构复杂，具有与其他颈椎不同的解剖学特征，功能特殊，邻近颈髓、椎动脉和颈神经等重要结构，此区的畸形与病损常导致严重的临床后果；又因部位深在及生物力学性质独特，最不稳定，其病损的诊断和治疗相对复杂和棘手，一直是脊柱外科的难点之一。保守治疗不愈合率高达50%～80%[1]，齿状突骨折不稳未经治疗或治疗不当造成的不愈合率为41.7%～72.0%[2]，故手术治疗已成为首选的治疗方法，随着医学诊疗技术不断改进提高，寰枢椎不稳的外科治疗不断发展进步[3]，各种内固定方法均有其优缺点。本文就寰枢椎不稳前后路内固定技术的进展予以综述。, 百拇医药(黄克敏 熊波 刘社庭)