探讨用"手动钝性扩孔"置入寰枢椎椎弓根螺钉内固定植骨融合治疗上颈椎不稳的临床效果。

2011年1月至2016年6月江苏省连云港市第二人民医院共收治19例上颈椎不稳患者，均表现为不同程度的枕颈区疼痛，活动受限，具有寰枢椎后路内固定融合手术指征。19例患者经"手动钝性扩孔"均行寰枢椎椎弓根螺钉固定，随访治疗效果。

19例患者手术过程均顺利，共置入76枚螺钉，所有螺钉均一次性成功置入，未发生技术上的困难；术中无脊髓和椎动脉损伤发生，术中出血量200~630 ml，平均340 ml；手术时间1.5~3.5 h，平均2.6 h；19例均获随访，随访5~20个月，平均8个月。术后CT复查示螺钉位置良好，末次随访内固定物无断裂、松动及复位变形。术后3~6个月患者均获植骨融合；12例术前四肢麻木和运动障碍患者临床症状得到不同程度改善，神经功能恢复采用JOA评分法评定：术前评分4.5~15.8分，平均9分，术后6个月JOA评分（14.8±2.3）分。

"手动钝性扩孔"行寰枢椎椎弓根螺钉固定治疗上颈椎不稳，置钉准确率高，疗效可靠。

To explore the clinical outcomes and complications of C_1,2 pedicle screw internal fixation and bone graft fusion in treating upper cervical instability via manual blunt reaming.

From January 2011 to June 2016, 19 patients with upper cervical instability were treated by C_1,2 pedicle screw internal fixation and bone graft fusion. All cases presented with atlantoaxial instability such as cranio-cervical junction pain.

A total of 76 screws were placed in the 19 cases. No injuries to the spinal cord or large blood vessels were reported. Blood loss ranged from 200 to 630 mL, with an average of 340 mL. Operative time ranged from 1.5 to 3.5 h, with an average of 2.6 h. The patients were followed for 5-20 months, with an average of 8 months. No screw loosening or breakage occurred and bony fusion was achieved in all cases. The clinical symptoms were improved to some extent after operation. The preoperative JOA scores were 4.5-15.8 (average, 9); mean postoperative JOA score was 14.8 ± 2.3.

Manual blunt reaming is both safe and reliable for the placements of C_1,2 pedicle screws.