颈椎椎弓根钉内固定治疗颈椎骨折脱位

[目的]探讨颈椎椎弓根钉内固定治疗颈椎骨折脱位的临床效果及影响因素。[方法]采用Axis系统经椎弓根内固定治疗颈椎骨折脱位41例。所有病例术前均行X线、CT及MRI检查并根据测量结果对每一椎弓根钉实施个体化置入。[结果]41例全部获得6～12个月随访，切口均Ⅰ期愈合，无1例近期死亡。共置入螺钉218枚，有196枚（90％）位置正确，22枚存在不同程度偏差，其中1l枚造成神经根损伤，1枚疑有血管损伤。有38例获得满意复位并骨性愈合，有3例因系陈旧骨折脱位术中未完全复位，术后出现神经根刺激症状，其中1例术后因退钉而改行前路手术。在25例脊髓及神经根损伤病例中，有6例系脊髓完全损伤，术后均无恢复；其余19例为脊髓和神经根不全损伤，术后神经功能均获明显改善甚至恢复正常。[结论]颈椎椎弓根钉内固定是治疗颈椎骨折脱位的安全有效方法之一。合理选择手术适应证，熟悉颈椎解剖结构。术中规范操作以及置钉个体化等是手术成功的关键。

Effects of the internal fixation for fracture and dislocation of cervical spine with pedicle screw

[Objective]To investigate the clinical effects of the internal fixation for fracture and dislocation of cervical spine with pedicle screws.[Method]Forty-one cases suffered from cervical fracture and dislocation were treated with Axis system.The patients all took X-ray,CT and MRI examinations before operations.Personal manipulation of every pedicle screw was attained according to the imaging measurement.[Result]All of the patients were followed up for six to twelve months postoperatively.One hundred and ninty-six of total 218 screws (90%) were in correct positon and 22 were incorrect.One nerve root injury and one doubtful blood vessel injury happened.Complete reduction and fracture union were obtained in 38 cases while inadequacy reduction and nerve root irritation existed in 3 cases,one of which suffered anterior approach operation on account of degeneration.Recovery didn't happen in the 6cases with complete spine injury.Ninteen cases with inadequacy spine injury recovered apparently even near normal level.[Conclusion]Cervical pedicle screw technique was identified to be safe and feasible for cervical fracture and dislocation.The key factors for a successful operation contain selection of patients,familiarity of the cervical anatomy,standard skill of manipulation and individuality of screw placement.