摘要目的 探讨以枢椎椎板置钉法完成寰枢或枕颈固定,用以治疗寰枢关节不稳的可行性.方法 对枢椎椎弓根畸形或椎动脉异位的病例以枢椎椎板置钉的方法 完成寰枢或枕颈固定.如果一侧枢椎椎弓根是大致正常的,就在该侧用椎弓根钉固定,在对侧用枢椎椎板钉固定.在寰椎以侧块螺钉固定,在枕骨以短螺钉固定.用连接棒在寰枢或枕枢间连接.在寰枢后弓间或枕骨与枢椎椎弓间植入颗粒状松质骨.结果 共完成了9个病例,其中寰枢固定2例,枕颈固定7例.使用一侧枢椎椎弓根钉固定、另一侧枢椎椎板钉固定6例,两侧均为椎板钉固定3例.9例均得到随访,随访时间4-13个月(平均9个月).所有病例均得到骨性融合.有神经症状的8例中,症状改善情况为:优3例,良1例,可2例,无变化2例.1例椎板钉进入了椎管.所有病例均没有出现脊髓和椎动脉损伤症状.结论 枢椎椎板置钉操作简便、安全,固定效果可靠.可以作为枢椎椎弓根置钉固定的后备方法 ,适用于椎弓根畸形或椎动脉异位的病例.

abstractsObjective C2 pedicle screw is the classic instrumentation for posterior C2 fixation.But it could be dangerous in case of anatomical variation, such as high riding vertebral artery and small C2 pedicle.C2 translaminar screw could be an alternative choice.This retrospective study is to evaluate the feasibility of C2 translaminar screw for atlantoaxial instability with anatomical variation.Methods In our clinical work, we had nine atlantoaxial instability cases with C2 pedicle malformation, ff the malformation is unilateral, we inserted one C2 translaminar screw and one C2 pedicle screw in the normal pedicle; if the malformation is bilateral, bilateral translaminar screws were used. Then C2 instrumentation could be connected with C1 lateral mass screw or occipital screw in cases with C1 occipitalization.Then atlantoaxial or occipitocervical fusion could be done with morselized autogenous cancellous iliac grafts.Results Nine cases had C2 translaminar screw, including 2 atlantoaxial fusion and 7 oceipitocervical fusion.Six cases had unilateral translaminar screw and 3 had bilateral translaminar screw.Radiographs demonstrated all the screws were placed satisfactorily except one.There was no neurological deterioration or vertebral artery injury.All the cases had an average follow-up of 9 months (4-13 months).All patients attained solid fusion without screw failure.In the 8 cases with neurological deficit, 3 were excellent, 1 was good, 2 were fair and 2 had no change.Conclusions C2 translaminar screw fixation could provide sufficient stability.This technique could be an alternative to standard C2 pedicle screw in cases with pedicle malformation and high riding vertebral artery.It is safe and simple in experienced hands.