APOFIX颈椎后路内固定治疗齿状突骨折合并脊髓损伤

目的　探讨APOFIX系统治疗枢椎齿状突骨折合并脊髓损伤的作用。方法　 13例齿状突骨折合并脊髓损伤患者 ,采用APOFIX颈椎后路内固定系统固定并植骨融合。结果　 13例均获 8～ 18个月随访 ,齿状突骨折均达到骨性愈合 ,神经功能获得不同程度恢复。结论　APOFIX内固定系统颈椎后路固定 ,稳定性好 ,固定确实 ,是一种治疗齿状突骨折并脊髓损伤的理想方法。     

APOFIX颈椎后路内固定治疗齿状突骨折合并脊髓损伤

目的：探讨APOFIX系统治疗枢椎齿状突骨折合并脊髓损伤的作用。方法：13例齿状突骨折合并脊髓损伤患者,采用APOFIX颈椎后路内固定系统固定并植骨融合。结果：13例均获8－18个月随访,齿状突骨折均达到骨性愈合,神经功能获得不同程度恢复。结论：APOFIX内固定系统颈椎后路固定,稳定性好,固定确实,是一种治疗齿状突骨折并脊髓损伤的理想方法。     

颈椎后路手术治疗齿状突骨折及其邻近节段损伤疗效分析

目的探讨颈椎后路手术治疗齿状突骨折及其邻近节段损伤的临床疗效。方法 2009-08-2013-08 21例齿状突及其邻近节段骨折脱位在我院行颈椎后路手术治疗患者。21例均采用上颈椎后路个性化的固定方式。随访观察患者临床症状和神经功能改善情况,对有脊髓损伤的患者,术前、术后6个月进行JOA评分,术后随访影像学资料评价骨折愈合、植骨融合等情况。结果所有病例术后均获得随访,平均随访时间18个月(12~48个月),术中未出现脊髓、椎动脉损伤等严重并发症。术后6个月临床症状得到明显改善,X线片示螺钉位置良好,无松动、断钉,所有骨折均呈骨性愈合。9例不完全性脊髓损伤患者术后脊髓神经功能ASIA分级均较术前提高,脊髓功能均获不同程度改善。JOA评分从术前平均(11.4-2.6)分提高至术后6个月平均(15.1-2.9)分,术前术后比较有统计学差异,平均改善率为(85.3%±8.3%),优良率95%。结论选择合理的颈椎后路手术方式,在治疗齿状突骨折及其邻近节段损伤中,能取得良好的疗效。     

上颈椎骨折脱位的外科治疗

目的探讨上颈椎骨折脱位的诊断及治疗方法。方法2005年1月—屯009年9月收治16例创伤性上颈椎骨折脱位患者。其中齿状突骨折7例,寰枢椎脱位5例,Hangman骨折2例,Jefferson骨折2例。9例伴有神经功能障碍者脊髓神经功能按ASIA分级：B级3例,c级4例,D级2例。除7例采用颈椎牵引及支具固定外,齿状突中空螺钉固定术2例,Apofix寰枢椎后路固定＋植骨融合2例,枕颈融合术1例,寰枢椎后路经椎弓根螺钉固定术4例。所有患者术后均行头颈胸支具外固定3个月。结果16例患者术后获6—36个月随访。所有病例未出现脊髓损伤、椎动脉破裂等并发症。经6个月以上随访骨折或植骨获愈合,未见内置物断裂或感染等并发症发生。1例患者枕颈融合术后2年因呼吸道感染并发症死亡。9例神经功能障碍患者中均有不同程度改善。上颈椎不稳均获得有效治疗。结论上颈椎外伤性失稳的诊断和治疗方式选择取决于骨折类型和移位状况。AndersonI、Ⅲ型齿状突骨折和LevineI、Ⅱ型Hangman骨折经保守治疗可获得满意的临床疗效。齿横韧带损伤合并寰枢关节脱位及不稳定的Jefferson骨折和Hangman骨折应手术治疗。寰枢椎后路组合固定技术是治疗上颈椎外伤性失稳的有效方法,具有固定可靠、短节段固定、三维固定、融合率高、可早期功能锻炼的优点。     

下颈椎骨折脱位并脊髓损伤的治疗术式探讨

[目的]探讨不同入路手术方式治疗下颈椎骨折脱位合并脊髓损伤的临床疗效。[方法]2011年7月~2015年6月收治下颈椎骨折脱位合并脊髓损伤患者39例,术前Frankel分级A级5例,B级12例,C级14例,D级8例。根据骨折类型、脱位程度、脊髓受压评估情况、是否存在关节突骨折及交锁或者前后复合体损伤等因素选择手术方案。其中24例椎体骨折、椎间盘损伤、术前经颅骨牵引可复位者采用前路减压椎间植骨内固定术;7例颈椎脱位伴小关节骨折或脱位但不伴明显前中柱损伤者采用后路复位侧块螺钉内固定术;8例颈椎椎体骨折、椎间盘损伤、椎小关节脱位交锁、术前经大重量颅骨牵引不能复位者采用前后路联合复位减压固定融合术。比较三种手术方式的手术时间、术中出血量和平均固定节段数;术后定期复查,观察损伤节段的稳定性和融合率,测量Cobb角、椎体水平移位和Frankel评分表,评估脊髓功能恢复与脊柱损伤重建稳定性等情况。[结果]患者获得有效随访,随访时间6~30个月,平均18个月,术后4~6个月均获得良好的骨性融合,均未出现严重并发症。联合入路组手术时间、出血量和平均固定节段数均较单纯前路或后路组长,而后路手术的手术时间、出血量和平均固定节段数明显多于前路手术组(P<0.05);除2例术前Frankel分级A级无恢复外,其余患者均有不同程度恢复,脊髓功能平均提高1.2级。所有患者的术前JOA评分和颈椎复位参数较术后均有改善,差异有统计学意义(P<0.05)。[结论]采用前路手术、后路手术或前后路联合手术治疗下颈椎骨折脱位并脊髓损伤均能获得不错的治疗效果,但应根据颈椎损伤部位及类型采取适合的手术入路,根据病情制订个性化治疗方案。     

下颈椎骨折脱位并关节突交锁的手术方式选择

目的：探讨下颈椎骨折脱位伴关节突交锁的手术方式选择。方法：对68例下颈椎骨折脱位合并关节突交锁患者的临床资料进行回顾性分析。其中单侧小关节脱位33例,双侧小关节脱位35例。美国脊髓损伤学会（ASIA）评分：A级5例,B级11例,C级9例,D级10例。所有患者均于术前行颅骨牵引,关节突交锁复位的则行前路减压植骨融合内固定术治疗,否则,则行后路切开撬拨复位或关节突切除复位固定,前路植骨融合内固定术。结果：术中均无大血管、气管、食道、脊髓意外损伤。平均随访41．5个月,所有患者均复位良好,颈椎椎间高度和生理曲度维持良好,术后6个月后植骨全部融合,无钢板螺钉并发症。不完全性脊髓损伤患者术后神经功能均有一定程度恢复。结论：手术治疗下颈椎骨折脱位并关节突交锁疗效确切,根据损伤的具体类型采用适合的手术方式是手术成功的关键。     

一期前后路联合内固定治疗严重下颈椎骨折脱位伴不完全脊髓损伤

目的 探讨一期后前联合人路内固定治疗严重下颈椎骨折脱位并不完全性脊髓损伤的有效性和可行性.方法 对11例严重下颈椎骨折脱位伴不完全性脊髓损伤患者的资料进行回顾性分析.患者采用一期前后联合手术复位、减压和内固定.术前ASIA评分:B级3例,C级6例,D级2例.结果 大部分患者术后获得完全复位.术后颈椎椎间高度、生理曲度无丢失.患者术后ASLA评分平均提高1～2级,未见内植物松动、脱落及断裂者,植骨在3～4个月内融合,未出现与手术相关的并发症.结论 颈椎前后路一期联合手术内固定可使损伤节段获得早期减压和稳定,为神经功能恢复创造有利条件,是可行的治疗选择.     

小儿颈椎及颈脊髓损伤的影像学诊断

总结小儿颈椎及颈脊髓损伤的影像学诊断经验。回顾分析 59例小儿颈椎及颈脊髓损伤 ,全部病例均常规摄颈椎正、侧位片及齿状突开口位片 ,2 5例摄断层 ,2 8例摄屈 /伸侧位片。 2 1例行CT扫描 ,2 6例行MRI检查。上颈椎损伤 4 6例 ,其中寰椎椎弓骨折 9例 ,枢椎骨折 7例 ,齿状突骨折 2 1例 ,寰椎椎弓骨折合并齿状突骨折 1例 ,寰椎横韧带断裂 8例 ;下颈椎损伤 1 1例 ,其中椎体骨折 3例 ,脱位 2例 ,骨折脱位 6例 ;多节段间隔性颈椎损伤 2例 ,无X线异常的脊髓损伤 (SCIWORA) 3例。认为影像学检查对于小儿颈椎及颈脊髓损伤的诊断具有重要价值 ,对怀疑有颈椎及颈脊髓损伤的小儿患者应常规摄颈椎正、侧位片及齿状突开口位片 ,小儿颈椎SCIWORA应常规行颈椎MRI检查     

下颈椎骨折脱位伴关节突绞锁的治疗策略

目的 探讨下颈椎骨折脱位伴关节突绞锁的治疗策略. 方法 对2007年11月至2010年12月收治的20例下颈椎骨折脱位伴关节突绞锁患者的临床资料进行回顾性研究,男15例,女5例;年龄19 ～74岁,平均40岁;损伤节段:C3.4 2例,C4.5 8例,C5.6 6例,C6.7 4例;其中单侧关节突绞锁5例,双侧关节突绞锁15例;同时伴关节突骨折或椎板骨折7例;术前脊髓损伤情况采用改良Frankel分级:A级3例,B级5例,C级10例,D级2例.19例骨折脱位处无椎间盘突出者均于术前行颅骨牵引,关节突绞锁复位的行前路减压植骨融合内固定术;未复位者行后路切开撬拨复位或关节突切除复位侧块钢板固定、前路植骨融合内同定术,1例C6.7骨折脱位者C6.7椎间盘突出并且位于上位椎体后侧,行C6椎体次全切除复位植骨内固定术.结果 所有患者术后获12～24个月(平均18个月)随访,均获复位,颈椎椎间高度和生理曲度维持良好,术后4个月X线片示植骨全部融合,无内固定断裂、移位等并发症发生.除完全脊髓损伤的3例患者神经功能无恢复外,其他患者脊髓损伤均至少有1级以上恢复:5例B级患者恢复至C级4例、D级1例,10例C级患者恢复至D级6例、E级4例,2例D级患者恢复至E级.结论 采用颈椎前路、后前或前后联合入路治疗下颈椎骨折脱位伴关节突绞锁疗效确切,根据损伤类型、颅骨牵引复位与否等综合因素选择适合的手术方式是治疗成功的关键.     

寰枢椎椎弓根螺钉固定治疗Jefferson骨折合并齿状突骨折

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。     

Imaging diagnosis of cervical spine and spinal cord injuries in children

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强直性脊柱炎脊柱骨折的治疗

目的 了解强且性脊柱炎(AS)脊柱骨折治疗的特点及注意事项。方法对19例AS脊柱骨折病例进行回顾性分析硬随访,19例中颈椎骨折11例,9例发生在C5-7间;胸腰椎骨折8例,7例为应力骨折,均发生存T10-L2间。二柱骨折16例。9例并发脊髓损伤,其中8例为颈椎骨折。所有19例患者均接受了手术治疗。颈椎骨折或脱位采用了4种手术方式,其中9例做了前路间盘切除或椎体次全切除、椎间值骨加钢板内固定术。胸腰椎骨折也做了4种术式,其中5例的术式为后路长节段固定加前、后联合融合,结果术岳18例患者获得了平均46．4个月的随访。并发脊髓损伤的9例患者,术后8例的神经功能有恢复。18例患者的骨折部位均已骨性愈合一术中并发脊髓损伤2例,因脑血管意外死亡1例,并发肺炎2例。结论 AS脊柱骨折好发于下颈椎及胸腰段,大多为三柱骨折,颈椎骨折并发脊髓损伤的发生率较高。胸腰椎多为应力骨折一手术治疗可使大多数患者的骨折愈合良好,神经功能有不同程度的恢复。对颈椎骨折患者,可采用前路椎体问植骨、钢板内固定的术式;而对于胸腰椎骨折,主张后路长节段固定,前、后联合植骨融合,术中及术后均可能出现并发症,应注意预防或避免。     

Evaluation of morbidity,mortality and outcome following cervical spine injuries in elderly patients

We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66–93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1–9 years) and mean in-hospital stay was 10 days (2–90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with neurologically deficit at time of injury. Outcome of the injury was related to increasing age, co-morbidity and the severity of neurological deficit. Injuries of the cervical spine are not infrequent occurrence in the elderly and occur with relatively minor trauma. Neck pain in the elderly patients should be thoroughly evaluated to exclude C2 injuries. Most patients can be managed in an orthosis but unstable injuries require rigid external immobilization or surgical stabilization.     

Verletzungen der Halswirbelsäule bei der diffusen idiopathischen skelettalen Hyperostose

The incidence of diffuse idiopathic sceletal hyperostosis (DISH) is described in men more than 50 years old up to 25% and in women up to 15%. Even little trauma in patients with DISH often leads to injuries of the spine, especially the cervical spine. In many cases MRI is necessary to find the injury in this anatomically modified spine. It is often difficult to detect the injury by plane radiographs or even CT. Based on two cases of cervical spine fractures in patients with DISH we will describe the difficulties and specialities in the diagnostics and surgical treatment of injuries of the cervical spine in patients with DISH. In the one case we stabilized a patient with an odontoid fracture type Andersson II, the other case was a traumatic spondylolisthesis C4/C5. Both cases were treated operatively, the odontoid fracture was stabilized by a single screw, the spodylolisthesis by a ventral plate. If there are modifications in the spinal anatomy by degenerative diseases like DISH or spondylitis ankylosans, it is important to perform an intense search for injuries of the spine. In many cases MRI is indicated to detect the injury because plane radiographs and CT are not sensitive enough. For the planning of the operation it is important to meet concerns to the thick anterior longitudinal ligament and to use screws, that are long enough because the use of standard instruments is often not successful.     

寰椎骨折合并不连续下颈椎骨折脱位的外科治疗

目的:探讨寰椎骨折合并不连续下颈椎骨折脱位的治疗方法及效果.方法:回顾性分析2005年10月～2011年5月收治的20例寰椎骨折合并不连续下颈椎骨折脱位患者的一期手术治疗效果.男13例,女7例,平均年龄36岁.5例寰椎粉碎性骨折合并有寰椎侧块内侧骨性结构附着处横韧带撕裂(DickmanⅡ型),3例双侧前弓骨折(前1/2 Jefferson骨折),5例单侧前后弓双骨折(半环Jefferson骨折),2例前3/4 Jefferson骨折(前弓二处、后弓一处骨折),5例后3/4 Jefferson骨折(前弓一处、后弓二处骨折).其中并存下颈椎骨折脱位按Allen分型:屈曲压缩型5例,牵张压缩型3例,垂直压缩型8例,屈曲牵张型2例,伸展牵张型2例.20例患者均行上、下颈椎一期手术治疗:5例行后路C1-C2固定融合术,7例行口咽入路钢板内固定术,8例行单纯C1后路螺钉固定术;9例并发脊髓不完全损伤来自于下颈椎骨折脱位者,先行下颈椎融合固定,无脊髓损伤11例患者,先固定相对不稳定节段.随访观察治疗效果.结果:平均手术时间200min( 180～240min);平均失血量760ml(500～1600ml).2例因电刀灼伤C1-C2间血管静脉丛导致出血,行止血纱布、脑棉片填塞止血,未出现颅脑缺血症状;其他病例未出现与手术直接相关并发症及长期卧床所导致的并发症.患者均于术后3d颈托固定后下地行走.随访8～42个月,平均26个月.9例合并脊髓不完全损伤者术后神经功能Frankel分级均有1个级别恢复.复查X线片和CT,未发现患者颈椎失稳或复位丢失,螺钉位置良好,无松动、断钉,寰椎骨折及下颈椎骨折脱位均获骨性愈合.结论:手术治疗寰椎骨折合并不连续下颈椎骨折脱位利于患者早期下床活动,减少长期卧床并发症,可获得较好疗效.     

Cervical spine injuries and management: experience with 235 patients in 10 years.

During the past 10-year period 235 patients with cervical injury were included in this study. In this paper we present our clinical experiences in patients with cervical spine injury treated surgically and conservatively and their outcome. Only few data exist on the treatment of cervical spine injuries. The principles of the management are still controversial. The 235 patients with cervical spine injury admitted to our department were assessed with Frankel's grading scale and treated surgically and conservatively according to the type and level of the injury; 172 patients were treated surgically, and 63 patients were managed conservatively. The neurological state of the patients and the treatment modality are summarized in Table 1 and Table 2. In the upper cervical injury, except type II odontoid fracture with a dislocation of more than 6 mm, conservative treatment modalities were performed. In the lower cervical injury, an anterior approach with discectomy and anterior fusion were performed if there was spinal cord compression anteriorly. Otherwise a posterior approach with decompression and a variety of posterior fusion techniques were used.     

下颈椎损伤改良Moore分类的临床应用研究

目的：探讨改良Moore分类法在下颈椎损伤中的临床应用。方法：2006年8月至2010年3月收治下颈椎损伤患者200例,男165例,女35例;年龄19-88岁,平均52岁。应用下颈椎损伤改良Moore分类全面地描述下颈椎损伤的状态,颈椎损伤严重程度（稳定性）量化评分与有否神经症状表现相结合,根据骨折类型和稳定性、脊髓或神经根受压损伤情况、韧带损伤后的稳定程度及其他参考因素进行分类诊治,选择治疗方法。其中伴有脊髓神经损伤者130例（ASIA评分：A级6例,B级13例,C级43例,D级68例）,不伴有脊髓神经损伤者70例。对伴有脊髓神经损伤的下颈椎损伤患者,根据ASIA评分进行疗效评定;对不伴有脊髓神经损伤的患者,根据影像学检查对颈椎的序列和高度进行观察。结果：前、左、右侧和后柱均损伤35例;前柱损伤33例;前、后柱均损伤90例;前、左侧和后柱均损伤5例;前、右侧和后柱均损伤3例;前、左侧和右侧柱均损伤3例;前、右侧柱损伤2例;前、左侧柱损伤5例;后柱损伤12例;左侧柱损伤7例;右侧柱损伤5例。200例患者中手术治疗98例,非手术治疗102例（其中可以手术而患者家属要求非手术治疗39例）。完全性脊髓损伤患者中3例行手术后脊髓功能无恢复迹象,ASIA分级无变化,但其肢体麻木、疼痛等症状有不同程度的缓解,另3例未手术患者脊髓功能及肢体症状均无变化。不完全性脊髓损伤患者手术后脊髓功能均有一定程度恢复,ASIA评分平均提高1．2级。未手术的不完全性脊髓损伤患者非手术治疗后ASIA评分平均提高0.3级。不伴有脊髓神经损伤者手术后经影像学检查显示均恢复了颈椎的正常序列和高度。结论：根据改良Moore分类法,稳定性量化评分值大于等于4分有下颈椎不稳可能,需要手术治疗,分值越大,手术指征越明显,若伴有脊髓或神经根受压损伤表现者则有绝对手术指征。稳定性量化评分为3分且伴有脊髓或神经根受压损伤表现者一般也有手术指征。稳定性量化评分为3分不伴有脊髓或神经根受压损伤表现者或3分以下者均不需要手术治疗。应用改良Moore分类法有利于下颈椎损伤患者的临床规范化、标准化诊治,以获得较满意的疗效。     

Stabilization of subaxial cervical spinal injuries

With subaxial cervical spine fractures, it has not been established which injuries can be adequately stabilized by external orthoses and which will require surgical stabilization. After review of 64 consecutive patients with C₃-C₇ spinal injuries, fracture characteristics on admission roentgenograms were identified that accurately predict the success or failure of nonoperative management. These include evidence of severe ligamentous injury (SLI) and severe vertebral body injury (SVBI). The presence of SLI, SVBI, or both SLI and SVBI correlated strongly with nonoperative stabilization failure (p < 0.001, P = 0.002, and P = 0.004, respectively). Injuries without SLI or SVBI were all successfully stabilized by cervical orthoses. Additionally, characterizing injuries by evidence of SLI and SVBI directs the approach for surgical stabilization.