短节段椎弓根螺钉内固定在牵引复位失败的下颈椎脱位患者的临床应用

目的探讨后路短节段颈椎椎弓根内固定技术在牵引复位失败的下颈椎脱位患者的临床应用。方法2007年9月一2012年1月，我科采用后路手术复位、短节段颈椎椎弓根螺钉内固定技术，治疗经过颅骨牵引仍不能复位的下颈椎脱位19例，并对该组患者的临床资料进行了回顾性分析。结果本组均获随访，随访时间9～16个月，平均12．3个月；术中未发生脊髓、神经根、椎动脉等损伤，术后患者颈椎序列恢复满意，脊髓功能除AISA分级A、E级患者外，均改善1—2级；共植入椎弓根螺钉42枚，38枚完全在椎弓根内；3枚向内穿破椎弓根皮质，未引起脊髓损伤；1枚向外部分穿入横突孔，未引起头昏、眩晕、偏瘫等症状。全部病例随访时未发现内固定松动、断裂，植骨已融合。结论对于牵引复位失败的下颈椎脱位患者，椎弓根螺钉内固定技术可以实现单一切口下松解复位以及短节段坚强固定，创伤小，临床疗效满意。

Clinical application of short segment pedicle screw fixation in reduction-failed patients with lower cervical dislocation

Objective To investigate the application of posterior short - segment pedicle screw fixation in patients with lower cervical dislocation that can＇t be reduced by skeletal traction. Methods From Sep. 2007 to Jan. 2012, 19 patients with cervical dislocations which could＇t be reduced by skeletal traction were treated with short-segment pedicle screw fixation. The clinical data of all these patients were retrospectively analyzed. Results All patients were followed up for 9 to 16 months（ average 12.3 months）. No injuries on spinal cord,nerve roots and vertebral artery were found during surgery, satisfactory postoperative cervical alignment and improved spinal cord function were recorded. Of all the 42 pediele screws,38 screws were completely implanted in the pedicles;3 screws penetrated the inner arch of pedicles without spinal cord injury ; 1 screw penetrated transverse foramen, which didn＇ t cause dizziness, vertigo and paralysis. At final follow up, all patients gained bone fusion without internal fixation failure. Conclusion For patients with lower cervical dislocation that cannot be reduced by skeletal traction, short segment pedicle screw fixation can achieve reduction and reliable fixation, with advantages of mini-invasiveness and satisfactory clinical results.