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首页> 外文期刊>British journal of neurosurgery >Occiput/C1-C2 fixations using intra-laminar screw of axis - A long-term follow-up
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Occiput/C1-C2 fixations using intra-laminar screw of axis - A long-term follow-up

机译：使用轴的椎板内螺钉固定枕骨/ C1-C2-长期随访

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Background. The surgical management of the craniocervical junction is challenging. Rigid posterior fixation of occiput/C1-C2 can be performed using a variety of surgical techniques including C2 pedicle/pars interarticularis, transarticular and intralaminar screw fixations. Methods. Forty-one patients were treated with occipital plate/C1 lateral mass and C2 intralaminar screw fixations for basilar invagination and congenital atlantoaxial subluxation, post-traumatic instability, tuberculous and rheumatoid arthritis-associated atlantoaxial dislocation. Out of forty-one, thirty-six patients had bilateral crossing intralaminar screws and five had ipsilateral laminar screw fixation bilaterally. Results. Follow-up was done in thirty-nine patients from 6 months to 8 years (mean: 21 months) and solid osseous fusion could be achieved in all (100%). One patient was lost to follow-up and another patient died of a cause unrelated to surgical technique. Pre-operative and post-operative Neurosurgical Cervical Spine Scale showed improvement in all patients having features of myelopathy. There were no neurological or vascular complications. However, nine patients had posterior laminar breach, eight had anterior laminar penetrations and three had wound infections. One patient had transient bulbar palsy and one patient had hardware failure in the form of avulsion of the midline occipital plate. Conclusions. Intra-laminar screw fixation is a safe alternative to transarticular and transpedicular/pars interarticularis fixation of C2 with advantage of having no risk of injury to vertebral artery and comparable biomechanical and pull-out strength.
机译：背景。颅颈交界处的外科手术处理具有挑战性。可以使用多种外科手术技术对枕骨/ C1-C2进行刚性后路固定，包括C2椎弓根/关节间，椎间和椎板内螺钉固定。方法。 41例患者接受枕板/ C1侧块和C2椎板椎弓根螺钉固定术治疗基底内陷和先天性寰枢椎半脱位，创伤后不稳定，结核性和类风湿性关节炎相关的寰枢椎脱位。在四十一名患者中，三十六名患者有双侧交叉椎板内螺钉，五名患者有同侧椎板螺钉固定。结果。对6个月至8年（平均21个月）的39例患者进行了随访，所有患者均可以实现牢固的骨融合（100％）。一名患者失去随访，另一名患者死于与手术技术无关的原因。术前和术后神经外科颈椎量表对所有具有脊髓病特征的患者均有改善。没有神经或血管并发症。但是，有9例患者发生了后层裂，有8例发生了前层穿透，还有3例发生了伤口感染。一名患者患有短暂性延髓性麻痹，一名患者具有中线枕骨撕脱形式的硬件故障。结论椎弓根内螺钉固定术是C2的经关节和经蒂/椎弓根间固定术的安全替代方法，其优点是无损伤椎动脉的风险，并且具有相当的生物力学和抗拉强度。

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