创伤性上颈椎不稳的手术治疗策略

目的探讨创伤性上颈椎不稳的手术治疗方式,以指导临床应用。方法本院脊柱外科自2002年1月～2007年6月共有46例创伤性上颈椎不稳患者,其中寰椎骨折合并寰椎横韧带损伤11例,寰椎横韧带损伤4例,陈旧性寰枢关节旋转性脱位1例,齿状突骨折20例,Hangman骨折10例;MRI示有脊髓受压表现者14例。所有患者入院后即予颅环弓牵引,完善术前准备后分别予前路齿状突空心加压螺钉内固定术或C2/3椎间盘切除、植骨融合、钢板内固定术,后路Atlas钛缆内固定术、Apofix内固定术、Magerl内固定术、侧块钉板固定术或枕颈融合术及前后联合入路手术治疗。结果术中未出现脊髓损伤、椎动脉破裂等并发症。所有患者均得到6～36个月的随访(平均18个月);未出现内固定松动、脱出及断裂现象,未发现脊髓神经损伤加重征象,无明显颈椎畸形遗留。全部病例均获骨折愈合或骨性融合。结论恰当的手术方式是治疗创伤性上颈椎不稳的基础,而手术的目的是获得上颈椎最大限度的生理功能。

Surgical management for traumatic instability of upper cervical spine

[Objective] To study the surgical management for traumatic instability of upper cervical spine and offer suitable methods to the clinic practice. [Methods] 46 patients with traumatic instability of upper cervical spine treated at our hospital from Jan. 2002 to June 2007 were retrospected and analysed. There were 11 cases of atlas fracture with rupture of transverse ligament, 4 cases of disrupted transverse ligament, 1 case of old atlanto-axial dislocation, 20 cases of odontoid fracture, 10 cases of Hangman fracture. 14 cases, examinated by MRI, had their spinal cords compressed after skull traction, and all cases were treated by posterior operation, anterior operation or their combination. [Results] There were no intraoperative complications such as vertebral artery injury and spinal cord damage. All cases performed 6 to 36 months(mean 18 months)follow-up, the internal fixation did not loose and broken, the complications of injuried spine cord did not aggraviate; their fractures were cured entirely and they got bony union. [Conclusion] A proper surgical method is the foundation to deal with traumatic instability of upper cervical spine and to obtain the largest range of physiologic ability is the purpose of surgical management.