后路短节段固定与植髂骨融合治疗上颈椎损伤

目的：探讨后路短节段固定、植髂骨融合治疗上颈椎损伤的手术策略及临床疗效。方法：回顾性研究2005 年6月至2013年9月收治的上颈椎损伤患者334例，其中适合进行后路短节段固定、植髂骨融合的36例(包括交通事故伤 23例，高处坠落6例，重物砸伤5例，他人殴打致伤2例)，均行后路短节段固定、植髂骨融合治疗，根据头颈部疼痛视 觉模拟评分法(visual analogue score，VAS)评分、神经功能障碍JOA评分、植骨后骨质融合率来探讨手术策略及分析临床 疗效。结果：术中无椎动脉、脊髓及神经根损伤发生，手术时间110~240 min。VAS评分术前与术后比较差异有统计学 意义(P<0.001)；JOA评分术前与术后比较差异有统计学意义(P<0.05)。术后随访无内固定失败，融合节段在随访过程 中均获得骨性融合。结论：根据每个上颈椎损伤患者不同的病情，选择个性化的后路短节段固定方法，同时取自体 髂骨融合，可取得良好的临床疗效。

Posterior short-segment fusion to treat upper cervical vertebra trauma

Objective: To investigate the strategies of posterior short-segment fi xation and plant iliac fusion surgery, and the clinical effi cacy of them on the treatment of upper cervical vertebra trauma. Methods: Three hundred and thirty-four patients with upper cervical vertebra trauma admitted into our hospital from June, 2005 to April, 2010 were studied retrospectively. Th irty-six were treated by posterior short-segment fusion, which included 22 and 14 male and female patients, respectively. Among them, 23 or 6 patients were related to traffi c or falling accident, 5 or 2 patients were related to crashing object or fi ght. Th e clinical effi cacy was evaluated by head and neck pain VAS score, JOA scores of nerve function and the rate of graft bone fusion. Results: Th e postoperative VAS scores were lower than that of pre-operation, and the diff erence was signifi cant (P<0.001). Th e postoperative JOA scores of nerve function was superior to preoperative scores (P<0.05). During follow-up, no internal fi xation failure happened while bony fusion could be seen. Conclusion: The method of posterior short-segment fixation and bone graft fusion in treating patients with cervical spine injury is highly efficacy, which possesses great clinical value.