枢椎骨折合并相邻节段不稳手术方法的选择

目的通过医学影像学资料回顾性研究,为治疗枢椎骨折合并相邻节段不稳选择合理的手术方法。方法回顾性分析13例枢椎骨折的相关资料,依据枢椎骨折的类型及相邻节段稳定情况,采用颈前路钢板植骨内固定术2例,后路C1、2椎弓根钉固定术3例,后路C2、3椎弓根钉固定术3例,后路寰枢椎椎弓根钉加C3侧块螺钉固定术2例,齿状突螺钉内固定术3例。结果本组获随防6~24个月(平均12个月),术后3个月均获得骨性融合,无内固定系统松动、断钉,无脊髓神经、椎动脉损伤等手术并发症。临床症状明显改善,颈椎生理曲度保持良好,合并脊髓损伤的3例,按ASIA分级均有不同程度恢复。结论针对枢椎骨折的类型及相邻节段不稳的情况,合理选择个性化手术方案,可以获得良好的疗效。

Choice of methods of operation for treatment of axis fracture combined with adjacent segment instability

Objective To provide reasonable operation method for treatment of axis fracture combined with adjacent segment instability through the medical imaging material retrospective study.Methods A retrospective study was performed on 13 axis fracture patients’ related material.According to the type of atlas fracture and the stabilities of adjacent segment,treatment strategies included anterior cervical plate internal fixation and fusion in 2 cases,posterior C1、2 pedicle screw fixation in 3 cases,posterior C2、3 pedicle screw fixation in 3 cases,posterior C1、2 pedicle screw and C3 lateral mass screws fixation in 2 cases,odontoid screw fixation in 3 cases.Results All the patients were followed up for 6~24 months(average 12 months),and they all showed bony fusion 3 months after operation,with no intraoperative surgery related complications such as loosening,breakage of fixation,spinal cord damage,vertebral artery injury.Clinical symptoms improved obviously,and cervical vertebra kept good physiological curvature.According to ASIA scale,3 patients with spinal cord injury had different degrees of neural functional recovery.Conclusion Reasonably selecting the personalized operation method is based on the type of axis fracture and the stabilities of adjacent segment,active treatment can lead to better effect.