选择性上颈椎椎弓根内固定治疗外伤性上颈椎不稳定性骨折脱位

目的探讨选择性上颈椎椎弓根内固定治疗外伤性上颈椎不稳定性骨折脱位的外科治疗方法及价值.方法对17例外伤性上颈椎不稳定性骨折脱位行选择性上颈椎椎弓根内固定治疗,其中C1、C2骨折伴旋转脱位4例,行C1、C2、C3椎椎弓根内固定治疗;Hangman骨折6例,按Levine—Edwards分型标准：Ⅱb型2例,Ⅲ型4例,6列均行C2、C3椎椎弓根内固定;Ⅱ型齿状突骨折伴C1不稳定5例,Jefferson骨折2例,行C1、C2椎弓根内固定及自体髂骨植骨.17例中,脊髓神经损伤9例,按Frankel分级：C级2例,D级7例.结果随访5月~3 a,平均2 a 3个月,1例残留颈部疼痛,半年后症状明显减轻,余16例颈痛症状完全消失;术后3~6个月骨折愈合,C2、C3获得骨性融合;颈部前屈活动受限2例;1例枕部皮肤疼痛,感觉过敏,经营养神经,高压氧治疗,2月后完全恢复;1例髂骨取骨区感染,占14.2%,经VSD引流,Ⅱ期缝合后治愈.神经损伤患者中1例C级恢复至D级,其余病例神经症状完全恢复,未出现脊髓神经症状加重、大血管损伤、脑脊液漏、植骨不融合和颈部切口感染等并发症.结论采用选择性的上颈椎椎弓根内固定治疗外伤性上颈椎不稳定性骨折脱位,必要时结合自体髂骨植骨,固定节段少,最大限度保留了颈椎的运动节段,骨折复位良好,固定牢固,神经功能改善良好,并发症发生率低,但应重视早期颈项肌功能锻炼及并发症的防治,以最大限度恢复颈椎功能.

Clinical Analysis of Selective Upper Cervical Pedicle Internal Fixation in the Treatment of Traumatic Upper Cervical Vertebra Instability Fracture Dislocation

Objectives To investigate the method and value of selective cervical pedicle internal fixation in the treatment of traumatic upper cervical vertebra instability fracture dislocation. Methods 17 cases of traumatic cervical spine fracture dislocation were treated with the selective cervical pedicle internal fixation. There were 4 cases of C1,C2 fractures with rotating dislocation using C1.C2.C3 vertebral pedicle internal fixation treatment. There were 6cases of Hangman fracture. According to Levine-Edwards classification,there were 2 cases of Ⅱb type and 4 cases of Ⅲ type. 6 cases were performed C2,C3 vertebral pedicle internal fixation. There were 5 cases of type Ⅱ odontoid fracture with C1 unstable and 2 cases of Jefferson fracture were treated with C1,C2 pedicle internal fixation and autogenous iliac bone graft. In all 17 cases,9 cases had spinal cord injury. According the Frankel classification,there were 2 grade C and 7 grade D.Results 17 cases were followed up for 5 months to 3 years,（mean,2years 3 months）,1 case had residual neck pain,and symptoms significantly reduced after half a year. The remaining 16 cases of neck pain symptoms disappeared entirely. 3 ~ 6 months after surgery, we found fracture healing and C2,C3 bony fusion.Cervical anteflexion limited activities were found in 2 cases. 1 case with occipital skin allergy and hyperesthesia was used neurotrophic agent and hyperbaric oxygen therapy, fully recover in 2months. 1 caseappeared iliacbonearea infection,accounted for 14.2%,the VSD drainage, Ⅱ period suture after cured. In patients with nerve injury in 1 C level recovery to D, neurological condition in which the remaining cases were fully recovered. All of the patients had no symptoms of spinal cord is aggravating, major vascular injury,cerebrospinal fluid leakage,no bone graft fusion and neck incision complications such as infection.Conclusions Selective upper cervical pedicle internal fixation in the treatment of traumatic cervical vertebra instability fracture dislocation should be co