摘要
目的探讨经寰枢椎椎弓根螺钉内固定治疗Jefferson骨折合并寰枢椎不稳的临床疗效。方法选择2006年1月-2009年12月采用经寰枢椎椎弓根螺钉内固定术治疗的Jefferson骨折合并寰枢椎不稳患者11例，其中男8例，女3例；年龄20～52岁，平均36岁。新鲜骨折8例，陈旧性骨折3例，合并齿状突骨折3例。术前无四肢神经症状，表现为头部旋转活动受限、枕颈部疼痛，术前均行X线片、CT及三维重建、MRI等影像学检查及颅骨牵引术。在全身麻醉下行后路经寰枢椎椎弓根螺钉内固定，寰枢椎之间未植骨融合。结果寰枢椎脱位患者完全复位，术后第3天在颈托保护下离床活动，术中无椎动脉、脊髓及神经根损伤发生，有1例发生静脉丛损伤出血，经用止血纱布填塞止血。随访6～24个月，平均15个月。结果显示骨折均骨性愈合，螺钉位置良好，无松动、断裂；7例患者术后15个月后取出内固定，颈椎旋转活动度轻度受限，旋转范围90°～135°，平均115°，屈伸活动无明显受限。结论寰枢椎椎弓根螺钉内固定治疗Jefferson骨折合并寰枢椎不稳，具有操作简便、固定节段短、固定牢靠、骨愈合率高的特点。
Objective To discuss the clinical outcomes of C1-C2 pedicle screw fixation in treatment of Jefferson fracture combined with atlantoaxial instability. Methods Eleven adult patients with Jefferson fracture combined with atlantoaxial instability were treated with C1 -C2 pedicle screw fixation in our department from January 2006 to December 2009. There were eight males and three females at age range of 20-52 years （ mean 36 years）. There were eight patients with fresh fractures, three with old fracture and three complicated with odontoid process fracture. The main preoperative clinical symptoms were the limitation of head torsion and pain in the occiput and neck, with no spinal dysfunction in all patients. X-ray, CT scan, three-dimensional reconstruction, MRI scan and skull traction were performed in all patients before operation. Then, the patients were treated with C1-C2 pedicle screw fixation without fusion between Cl-C2 under general anesthesia. Results The atlantoaxial dislocation was reduced completely and the patients could move from bed, wearing the neck collar. There was no injury of vertebral artery, spinal cord or nerve roots during operation, but one patient suffered the venous plexus bleeding which was packed with the hemostatic gauze. Eleven patients were followed up for 6-24 months （average 15 months） , which showed bone union, with no internal fixation breakage, loosening or dislocation. The internal fixation was removed from seven patients 15 months after operation, with mild limitation of the cervical vertebra torsion （90°-135°, average 115°） but with no limitation of obvious extension-flexion motion. Conclusion C1-C2 pedicle screw fixation has features of simple operation, short segment fixation, solid fixation and high rate of bone healing for treatment of Jefferson fracture combined with atlanto- axial instability.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2011年第10期873-877,共5页
Chinese Journal of Trauma
