颈椎后路双开门脊髓减压椎弓根内固定术治疗颈椎骨折脱位的效果分析

目的探讨颈椎后路双开门脊髓减压椎弓根内固定术治疗颈椎骨折脱位并脊髓损伤患者的治疗效果。方法2000年12月至2008年4月，行颈椎后路双开门脊髓减压椎弓根内固定术治疗38例颈椎骨折脱位并脊髓损伤患者，男28例，女10例；年龄20-80岁，平均43．5岁；颈椎损伤节段：C22例，C33例，C410例，C513例，C68例，C72例。术后行椎弓根螺钉CT检查并观察脊髓神经功能改善状况。结果38例患者C2-7共置入椎弓根螺钉158枚，其中152枚（96．2％）完全置入椎弓根皮质骨内，6枚（3．8％）置入位置不准确，包括进钉位置偏内经椎板进入椎管2枚，偏外挤穿椎弓根外侧皮质4枚。术后随访36例，随访时间1-36个月，平均6．8个月；脊髓神经损伤ASIA分类：A级7例、B级15例、C级13例、D级3例，A级的7例患者中5例感觉下降，恢复至B级；2例感觉完全恢复，上肢肌力有改善，但下肢运动功能无改善，分别恢复至C、D级。其余均有1-3级的功能恢复。无1例继发性血管、神经损伤。结论早期行后路双开门脊髓减压椎弓根内固定术以保持颈椎损伤阶段的稳定性，对颈椎骨折脱位并脊髓损伤患者的功能恢复有显著治疗作用。

Laminplasty and transpedicular screw fixation for cervical spinal cord injury

Objective To explore the effectiveness of laminplasty and transpedieular screw fixation for the cervical spinal cord injury. Methods Totally 38 patients with cervical fracture and dislocation and cervical spinal cord injuries were treated with transpedicular screw fixation and decompression of french door laminoplasty. All cases were checked with CT scan. Results Of the total 158 cervica pedicle screws inserted in 38 cases, among which 152 screws （96. 2% ） were full contained within the corticat boundaries of the pedicle, 6 screws （3.8%） penetrated spinal canal, and 4 screws were close to the vertebral artery. Conclusion were misplaced, 2 screws laterally Treatment of cervical spinal cord injury improves the motor and sensory functions of patients with cervical spine cord injuries. The bare-handed fixation of cervical pedicle screws is feasible and safe in this purpose.