前路椎弓根螺钉重建术在下颈椎骨折脱位中的临床应用

目的：探讨前路椎弓根螺钉治疗下颈椎骨折脱位的临床疗效。方法：自2009年1月至2011年12月，运用前路椎弓根螺钉技术治疗下颈骨折脱位18例，其中男12例，女6例；年龄17-47岁，平均38．2岁。下颈椎损伤严重程度SLIC评分6—9分，平均7．5分。ASIA脊髓损伤分级：A级2例，B级8例，C级6例，D级2例。18例患者术后均摄颈椎x线片及行CT检查，在CT横断位和矢状位上对螺钉进行安全性评级。定期随访，复查颈椎X线片及CT片了解损伤节段的稳定性和融合情况，术后3个月、末次随访时以ASIA脊髓损伤分级判定脊髓功能改善情况。结果：所有患者获得随访，时间为6～15个月，平均9．5个月。术后3个月ASIA脊髓损伤分级改善1级8例，2级2例；末次随访改善1级7例，2级4例。所有患者获得骨性融合，融合时间6-8个月，平均6．5个月。术后1例出现一过性声音嘶哑，术后2个月恢复；2例出现吞咽不适，经雾化吸入后，3周左右症状消失。未出现内固定断裂及松动脱出、神经血管及食道损伤等并发症。结论：下颈椎骨折脱位导致的“三柱”损伤采用前路椎弓根螺钉重建术，可以达到彻底减压的效果，能恢复颈椎高度及生理曲度，并且具有较好的稳定性，为脊髓功能恢复创造有利条件。

Clinical application of anterior transpediclar screw reconstruction in treating lower cervical spine fracture and dislocation

Objective: To investigate the clinical effects of anterior transpediclar screw(ATPS) fixation in treating lower cervical spine fracture and dislocation. Methods: From January 2009 to December 2011,18 patients with lower cervical spine fracture and dislocation were treated with ATPS technique,including 12 males and 6 females,aged from 17 to 47 years old with an average of 38.2 years. Severity score of lower cervical spine injuries (SLIC) ranged from 6 to 9 points with an average of 7.5 points. According to ASIA grade of spinal cord injury,2 cases were classified in grade A,8 cases in grade B,6 cases in grade C and 2 cases in grade D. X-ray and CT scan were done after surgery in order to evaluate the safety of ATPS and observe the stability and fusion of injured segment. Spinal cord function was evaluated according to ASIA grade at 3 months after operation and last follow-up. Results: All patients were followed up for 6 to 15 months with an average of 9.5 months. Three months after operation,in aspect of spinal cord function,8 cases improved 1 grade,2 cases improved 2 grades;and at final follow-up,7 cases improved 1 grade,4 cases improved 2 grades. All patients obtained bony fusion 6 to 8 months after operation with an average of 6.5 months. After operation,1 case had transient hoarseness and recovered 2 months later;2 cases felt swallowing discomfort,but the symptoms disappeared after about 3 weeks by inhalation. No internal fixation breakage and loosening as well as nerve,blood vessel and esophageal injuries were found. Conclusion: As for three columns injury caused by lower cervical spine fracture and dislocation,treatment with anterior transpediclar screw reconstruction can achieve the effect of decompression thoroughly and restore the cervical spine height and physiological curvature. Moreover,this kind of treatment has good stability and can create the favorable conditions for the recovery of spinal cord function.