摘要
目的:探讨寰枢椎椎弓根螺钉固定治疗Jefferson骨折合并齿状突骨折的可行性及临床疗效。方法:2002年12月～2006年6月采用后路寰枢椎椎弓根螺钉内固定术治疗Jefferson骨折合并齿状突骨折患者9例,其中男7例,女2例,年龄23～58岁,平均39.6岁;新鲜骨折6例,陈旧性骨折3例;齿状突骨折按Anderson分型:Ⅱ型8例,Ⅲ型1例;术前神经功能JOA评分8～15分,平均10.9分。术前均行X线、螺旋CT等影像学检查及颅骨牵引术;均在全麻直视下行复位、寰枢椎椎弓根螺钉系统固定术。结果:术中无椎动脉、脊髓及神经根损伤发生,7例寰枢椎骨折脱位完全复位,2例不完全复位;术后第3～6天(平均第4天)在颈托保护下离床活动;随访6～24个月,平均15个月,临床症状得到明显改善;手术6个月后复查X线、螺旋CT示所有骨折均呈骨性愈合,螺钉位置良好,无松动、断钉。术后1年神经功能JOA评分13～17分,平均15.9分,平均改善率为85.3%。结论:寰枢椎椎弓根螺钉内固定技术具有直视下置钉、复位,短节段固定、固定可靠及骨愈合率高等特点,为Jefferson骨折合并齿状突骨折患者提供了一种较好的治疗方法。
Objective：To explore the surgical feasibility and clinical outcome of aflantoaxial pedicle screw instrumentation for the treatment of Jefferson fracture associated with odontoid fracture.Method ：From December 2002 to June 2006,9 cases suffered with Jefferson fracture combined with odontoid fracture were included in this study.There were 7 males and 2 females,with a mean age of 39.6 years old（ranged 23 to 58 years old）. 6 cases were fresh fractures ,3 were old fractures.The odontoid fractures were classified according to Anderson and D＇Alonzo,which included Anderson Ⅱ for 8 cases and Anderson Ⅲ for 1 case.JOA scores of neurological function in preoperation were from 8 to 15,with an average of 10.9.The examination of X-ray film and SCT and skull traction were performed in each patient preoperatively.All cases underwent aflantoaxial pedicle screw instrumentation under general anesthesia.Result：No severe complications such as injuries to vertebral artery,nerve root and spinal cord intraoperatively or deterioration of spinal cord injury was observed postoper- atively.There were 7 cases with complete reduction,and 2 cases with incomplete reduction.The mean off-bed time was 4 days（from 3 to 6 days） after operation.All cases were followed up from 6 to 24 months,averaging 15 months.The clinical symptom improved significantly 6 months postoperatively.The X-ray and SCT scans verified all cases had solid bony union and all screws were in the properposition,no loosening or breaking of instrument were observed.The JOA scores at one year postoperatively were from 13 to 17,with an average of 15.9,with the average improve rate of 85.3%.Conclusion：The C1-C2 pedicle screw fixation has the advan- tages of direct screw placement,short-segment fixation,intraoperative reduction and high fusion rate,which could be used as an effective method for Jefferson fracture associated with odontoid fracture.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第1期50-54,共5页
Chinese Journal of Spine and Spinal Cord
