创伤性枢椎滑脱的手术治疗

目的探讨创伤性枢椎滑脱的稳定性判断标准、手术适应证、内固定方式选择等.方法对25例来自不同医院具有影像学资料的住院病例临床分析.稳定性判断根据Fransic标准和Coric标准.分类标准参照Levine-Edwards方案.手术方法以前路C2-3椎间植骨融合内固定为主.结果不稳定16例,稳定9例.Ⅰ型4例,Ⅱ型19例(占76%),Ⅱa2例,无Ⅲ型.14例CT检查中,对称性骨折4例;不对称性骨折10例,占71%.保守治疗12例,其中不稳定型8例,稳定型4例.手术治疗13例,Ⅰ型2例,Ⅱ型9例,Ⅱa型2例,其中不稳定型8例,稳定型5例.骨折均在3个月内愈合.结论TSA各家稳定性评判标准未必可靠,仍应结合动力X线片和牵引动态X线片观察结果.大多数病例只需保守治疗,手术指征应严格掌握.对Ⅱ型经保守治疗无效病例应手术.手术前、后入路各有其适应症.

The surgical treatment of traumatic spondylolisthesis of the axis

Objective To investigate the criteria of Stability,the optimal therapy,the respective indications for operative and conservative treatment,the Surgical technique over the therapeutical concept leading to optimal functional results for the traumatic spondylolisthesis of the Axis(TSA).Methods Twenty-five Patients of TSA were studied from1991to2003,which all had radiological films at admission.These materials were analyzed,among which13cases by comparison of pre-post operation,12cases by conservative treatment.The stability was assessed by the Francis and Coric criterias.According to the classification of Levine-Edwards,cases were divided.Surgical technique was mainly anterior fusion and bone graft and internal plate fixation between C 2-3 .Results16fractures were considered unstable and9stable.4cases were divided into Type I,19Type II(76%),2Type IIa,no Type III.Of the14cases investigated by CT,10cases were asymmetrical,of which7were unstable,4were symmetrical.On average healing occurred within three months.Conclusion The sorts of criterias of stability are unlikely reliable,ought to combine with results of dynamic radiograghs and cervical traction for deciding.The majority of TSA responds to a conservative treatment.The indications of operation should be strictly controled.Type II cases with no-effect on conservative treatment are recommended operation.The anterior and posterior approaches of surgery have merits respectively.