后路寰枢椎钉棒内固定技术优化的研究进展

doi:10.13418/j.issn.1001-165x.2025.1.17

摘要/Abstract

摘要： 寰枢椎脱位是上颈椎最常见的疾病之一，而钉棒内固定技术已成为后路寰枢椎应用最广泛的技术。近年来，大量研究对后路寰枢椎钉棒系统进行了优化，增加了置钉的安全性、内固定系统的稳定性及复位的能力。本文通过广泛查阅近年来国内外后路寰枢椎钉棒内固定技术优化的相关文献，从寰枢椎各种常用置钉方式的演进，特点及优化方式进行综述，以期为寰枢椎脱位治疗的临床决策提供帮助。

关键词: 寰枢关节, , , 钉棒内固定技术, , , 优化

Abstract: Atlantoaxial dislocation is one of the most common diseases of upper cervical vertebrae, and screw rod internal fixation has become the most widely used technique for posterior approach of atlantoaxial vertebrae. In recent years, a large number of studies have optimized the posterior atlantoaxial screw rod system, which has increased the safety of screw placement, the stability of internal fixation system and the ability of reduction. Through a comprehensive review of the pertinent literature on the optimization of posterior atlantoaxial screw-rod internal fixation technique both domestically and internationally over recent years, this paper reviews the evolution, characteristics, and optimization strategies of various commonly employed atlantoaxial screw placement technique, with the aim of assisting clinical decision-making in the management of atlantoaxial dislocation.

Key words: Atlanto-axial joint, , , Screw-rod internal fixation technique, , , Optimization

中图分类号:

R816.8

陈泽星, 邹小宝, 朱昌荣, 杨浩志, 练沛荣, 马仁财, 陈钧麟, 马向阳. 后路寰枢椎钉棒内固定技术优化的研究进展[J]. 中国临床解剖学杂志, 2025, 43(1): 107-111.

Chen Zexing, Zou Xiaobao, Zhu Changrong, Yang Haozhi , Lian Peirong, Ma Rencai, Chen Junlin, Ma Xiangyang . Research progress of screw-rod internal fixation technique optimization with posterior atlantoaxial fixation fusion[J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 107-111.

参考文献

[1] Gonzalez D, Ardura AF, Sanjuan JC, et al. C1-C2 rotatory subluxation in adults "A Narrative Review"[J]. Diagnostics (Basel), 2022, 12(7): 1615. DOI: 10.3390/diagnostics12071615.
[2] 宋梅, 赵改平, 段婉茹, 等. 不同后路内固定治疗颅底凹陷寰枢椎脱位的生物力学研究[J]. 医用生物力学, 2023, 38(1):37-44. DOI：10.16156/j.1004-7220.2023.01.005
[3] Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation[J]. Acta Neurochir (Wien), 1994, 129(1-2): 47-53. DOI: 10.1007/BF01400872.
[4] Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation[J]. Spine (Phila Pa 1976), 2001, 26(22):2467-2471. DOI: 10.1097/00007632-200111150-00014.
[5] Butt BB, Gagnet P, Piche J, et al. Lateral mass screw placement in the atlas: description of a novel surgical technique, radiographic parameters, and review of the literature[J]. J Spine Surg, 2021, 7(3): 335-343. DOI: 10.21037/jss-20-566.
[6] Liawrungrueang W, Riew KD, Sugandhavesa N, et al. Atlas (C1) lateral mass screw placement using the intersection between lateral mass and inferomedial edge of the posterior arch: a cadaveric study[J]. Eur Spine J, 2022, 31(12):3443-3451. DOI: 10.1007/s00586-022-07385-7.
[7] Bunmaprasert T, Puangkaew W, Sugandhavesa N, et al. The intersection between lateral mass and inferomedial edge of the C1 posterior arch: a reference point for C1 lateral mass screw insertion[J]. Neurospine,2021,18(2):328-335. DOI: 10.14245/ns.2040814.407.
[8] Singh DK, Shankar D, Chand VK, et al. C2 superior facetal osteotomy: a novel technique in complex craniovertebral junction surgery for C1 lateral mass screw placement[J]. Asian Spine J, 2023, 17(6):1125-1131. DOI:10.31616/asj.2023.0216.
[9] Du YQ, Yin Y H, Li T, et al. A novel surgical protocol for safe and accurate placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability: technical details, accuracy assessment and perioperative complications[J]. Eur Spine J, 2021, 30(6):1585-1595. DOI: 10.1007/s00586-021-06780-w.
[10] Dewan MC, Godil SS, Mendenhall SK, et al. C2 nerve root transection during C1 lateral mass screw fixation: does it affect functionality and quality of life? [J]. Neurosurgery, 2014, 74(5):475-481. DOI: 10.1227/NEU.0000000000000306.
[11] Lee HR, Lee DH, Cho JH, et al. Feasibility of lateral mass screw insertion in patients with the risky triad of C1: evaluation of the over-the-arch technique[J]. J Neurosurg Spine, 2021, 36(5):822-829. DOI: 10.3171/2021.8.SPINE21695.
[12] Tan M, Wang H, Wang Y, et al. Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass[J]. Spine (Phila Pa 1976), 2003, 28(9):888-895. DOI:10.1097/01.BRS.0000058719.48596.CC.
[13] 马向阳, 尹庆水, 吴增晖, 等. 寰椎椎弓根与枢椎侧块关系的解剖与临床研究[J]. 中华骨科杂志, 2004, 24(5): 295-298. DOI: 10.3760/j.issn:0253-2352.2004.05.009
[14] Huang DG, Hao DJ, He BR, et al. Posterior atlantoaxial fixation: a review of all techniques[J]. Spine J, 2015, 15(10):2271-2281. DOI: 10.1016/j.spinee.2015.07.008.
[15] Tan M, Dong L, Wang W, et al. Clinical application of the "pedicle exposure technique" for atlantoaxial instability patients with a narrow c1 posterior arch[J]. J Spinal Disord Tech, 2015, 28(1):25-30. DOI: 10.1097/BSD.0000000000000078.
[16] Yi P, Dong L, Tan M, et al. Clinical application of a revised screw technique via the C1 posterior arch and lateral mass in the pediatric population[J]. Pediatr Neurosurg, 2013, 49(3):159-165. DOI:: 10.1159/000358807.
[17] Zhang L, Wang H. Biomechanical Effects of Lateral Inclination C(1) and C(2) Pedicle Screws on Atlantoaxial Fixation[J]. Orthop Surg, 2021, 13(7):2027-2033. DOI: 10.1111/os.13137.
[18] Huang DG, He SM, Pan JW, et al. Is the 4 mm height of the vertebral artery groove really a limitation of C1 pedicle screw insertion? [J]. Eur Spine J, 2014, 23(5):1109-1114. DOI: 10.1007/s00586-014-3217-y.
[19] Jin GX, Wang H, Li L, et al. C1 posterior arch crossing screw fixation for atlantoaxial joint instability[J]. Spine (Phila Pa 1976), 2013, 38(22): E1397-E1404. DOI: 10.1097/BRS.0b013e3182a40869.
[20] Liu C, Kamara A, Yan Y. Biomechanical study of C1 posterior arch crossing screw and C2 lamina screw fixations for atlantoaxial joint instability[J]. J Orthop Surg Res,2020,15(1):156. DOI: 10.1186/s13018-020-01609-6.
[21] Shen K, Deng Z, Yang J, et al. Biomechanical study of novel unilateral C1 posterior arch screws and C2 laminar screws combined with an ipsilateral crossed C1-C2 pedicle screw-rod fixation for atlantoaxial instability[J]. Arch Orthop Trauma Surg, 2017, 137(10):1349-1355. DOI: 10.1007/s00402-017-2781-0.
[22] Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note[J]. J Spinal Disord Tech, 2004, 17(2):158-162. DOI: 10.1097/00024720-200404000-00014.
[23] 马向阳, 尹庆水, 吴增晖, 等. 枢椎椎板螺钉固定的解剖可行性研究[J]. 中国脊柱脊髓杂志, 2006, 16(1):48-51.
[24] Gorek J, Acaroglu E, Berven S, et al. Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation[J]. Spine (Phila Pa 1976),2005,30(13):1513-1518. DOI: 10.1097/01.brs.0000167827.84020.49.
[25] Paramore CG, Dickman CA, Sonntag VK. The anatomical suitability of the C1-2 complex for transarticular screw fixation[J]. J Neurosurg, 1996, 85(2):221-224. DOI: 10.3171/jns.1996.85.2.0221.
[26] Ma W, Feng L, Xu R, et al. Clinical application of C2 laminar screw technique[J]. Eur Spine J,2010,19(8):1312-1317. DOI: 10.1007/s00586-010-1447-1.
[27] 马向阳, 邹小宝, 付索超, 等. 枢椎棘突椎板螺钉固定技术的建立与初步临床应用[J]. 中华骨与关节外科杂志, 2023,16(5):408-413. DOI: 10.3969/j.issn.2095-9958.2023.05.03
[28] 王向阳, 徐华梓, 池永龙, 等. 改良枢椎椎板螺钉置钉方法的临床应用[J].脊柱外科杂志,2016,14(4):216-219. DOI: CNKI:SUN:JZWK. 0.2016-04-008
[29]马向阳, 尹庆水, 吴增晖, 等. 枢椎椎弓根螺钉进钉点的解剖定位研究[J]. 中华外科杂志, 2006, 44(8):562-564. DOI: 10.3760/j:issn:0529-5815.2006.08.018
[30] Resnick DK, Lapsiwala S, Trost GR. Anatomic suitability of the C1-C2 complex for pedicle screw fixation[J]. Spine (Phila Pa 1976),2002,27(14):1494-1498. DOI: 10.1097/00007632-200207150-00003.
[31] Lee KH, Kang DH, Lee CH, et al. Inferolateral entry point for c2 pedicle screw fixation in high cervical lesions[J]. J Korean Neurosurg Soc,2011,50(4):341-347. DOI: 10.3340/jkns.2011.50.4.341.
[32] Kepler CC, Fang T, Bronson WH, et al. The C2 "Parsicle" Screw: Introduction of a Novel Posterior Surgical Technique For Upper Cervical Fixation[J]. Clin Spine Surg,2020,33(4):146-149. DOI: 10.1097/BSD.0000000000000871.
[33] Patkar SV. New entry point for C2 screw, in posterior C1-C2 fixation (Goel-Harm's technique) significantly reducing the possibility of vertebral artery injury[J]. Neurol Res, 2016, 38(2):93-97. DOI: 10.1080/01616412.2015.1105582.
[34] 高延征, 高坤, 余正红, 等. “in-out-in”多皮质枢椎椎弓根螺钉在寰枢椎脱位或不稳后路手术中的应用[J]. 中国脊柱脊髓杂志, 2017, 27(1):55-60. DOI: 10.3969/j.issn.1004-406X.2017.01.10
[35] 高坤, 高延征, 邵佳, 等. 枕颈后路术中置入"in-out-in"枢椎椎弓根螺钉对椎动脉影响的观察研究[J]. 中华创伤骨科杂志,2022, 24(11):972-977.
[36] 张修儒, 高延征, 高坤, 等. 寰枢椎脱位伴复杂椎动脉变异的枢椎置钉策略[J]. 中华骨科杂志, 2023, 43(9):543-549. DOI: 10.3760/cma.j.cn121113-20221112-00656
[37] Moftakhar P, Gonzalez NR, Khoo LT, et al. Osseous and vascular anatomical variations within the C1-C2 complex: a radiographical study using computed tomography angiography[J]. Int J Med Robot,2008,4(2):158-164. DOI: 10.1002/rcs.193.
[38] Goel A, Rangnekar R, Shah A, et al. Mobilization of the Vertebral Artery-Surgical Option for C2 Screw Fixation in Cases With "High Riding" Vertebral Artery[J]. Oper Neurosurg (Hagerstown), 2020, 18(6):648-651. DOI: 10.1093/ons/opz289.
[39] Du YQ, Yin YH, Qiao GY, et al. C2 medial pedicle screw: a novel "in-out-in" technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus[J]. J Neurosurg Spine, 2020, 33(3): 281-287. DOI: 10.3171/2020.2.SPINE191517.
[40] 高坤, 高延征, 邵佳, 等. 内侧"in-out-in"枢椎椎弓根螺钉在上颈椎手术中的应用研究[J]. 中华神经医学杂志,2022, 21(8):789-794. DOI: 10.3760/cma.j.cn115354-20220511-00320

[41] Guo Q, Zhou X, Guo X, et al. C2 partial transpedicular screw technique for atlantoaxial dislocation with high-riding vertebral artery: A technique note with case series[J]. Clin Neurol Neurosurg, 2021, 200:106403. DOI: 10.1016/j.clineuro.2020.106403.

[42] 马向阳, 尹庆水, 夏虹, 等. 枢椎后路侧块螺钉固定的解剖研究[J]. 中国脊柱脊髓杂志, 2004, 14(7):33-36. DOI: 10.3969/j.issn.1004-406X. 2004.07.006
[43] 刘磊, 廖文波, 范红松, 等. 枢椎后路改良侧块螺钉钉道的CT测量[J]. 遵义医学院学报, 2017, 40(2):200-203. DOI: 10.3969/j.issn.1000-2715.2017.02.017
[44] Zhou S, Yuan B, Liu W, et al. Three-dimensional reduction method with a modified C2 isthmus screw in irreducible atlantoaxial dislocation: a technical note[J]. BMC Surg, 2021,21(1):324. DOI: 10.1186/s12893-021-01321-0.
[45] Shao M, Dai Y, Zhu W, et al. Bicortical Short C2 Pars Screw Fixation for High-Riding Vertebral Artery Provided Sufficient Biomechanical Stability: A Finite Element Study[J]. Spine (Phila Pa 1976),2022,47(4):369-375. DOI: 10.1097/BRS.0000000000004141.
[46] 卢敏明, 唐一钒, 陈雄生. 后路枢椎峡部螺钉固定技术的研究进展[J]. 中华骨科杂志, 2022, 42(23):1588-1594.
[47] 孙岩, 谭明生. 寰枢椎脱位翻修手术原因及策略研究进展[J]. 中国骨伤, 2022, 35(5): 495-499.
[48] Wang Y, Wang C, Yan M. Clinical Outcomes of Atlantoaxial Dislocation Combined with High-Riding Vertebral Artery Using C2 Translaminar Screws[J]. World Neurosurg,2019,122: e1511-e1518. DOI: 10.1016/j.wneu.2018.11.092.
[49] 张修儒, 高延征, 高坤, 等. 寰枢椎脱位术后翻修的手术策略分析[J]. 中国脊柱脊髓杂志,v2023, 33(11):961-969.
[50] Ma X, Zou X, Chen Z, et al. Surgical Failure and Revision Strategy for Atlantoaxial Dislocation: A retrospective study of 109 Cases[J]. Spine (Phila Pa 1976),2023. DOI: 10.1097/BRS.0000000000004894.