上颈椎失稳并脊髓不全损伤的外科治疗

Surgical management for upper cervical spine instability with incomplete spinal cord injury

目的讨论上颈椎失稳并脊髓不全损伤的诊断和治疗方法。方法男116例,女76例,平均年龄41岁。齿突骨折47例(新鲜骨折38例,陈旧性骨折9例),Hangman骨折45例(新鲜骨折28例,陈旧性骨折17例),寰椎横韧带断裂24例,先天畸形23例,寰椎单侧椎弓骨折19例,类风湿性关节炎17例,一侧关节凸骨折9例,Jefferson骨折并慢性不稳3例,肿瘤4例。齿突螺钉固定29例,颈2-3椎间融合10例,寰枢椎Apofix固定融合27例,颈枕融合Axis固定29例、Cervifix固定36例,Sim鄄mons寰枢固定融合32例,Brooks固定融合8例,钢丝加关节突螺钉固定8例。经椎弓根加压螺钉固定,植骨融合4例,其他方法1例。结果平均随访4年9个月。189例获得骨性愈合,延迟愈合3例,钢丝断裂2例,椎体移位1例。椎动脉损伤6例次,神经根损伤12例次,退钉10枚。JOA改善率79.9%,无脊髓损伤加重者。结论恰当的手术方法是治疗的基础,内固定物的选择可减少并发症。

Objective To discuss the diagnosis and surgical treatment of upper cervical spine instability with incomplete spinal cord injury. Methods 192 cases(male 116,female 76,with a average of 41 yrs.of age)of upper cervical spine instability with incomplete spinal cord injury were treated in this group. There were 47 cases of odontoid process fracture(38 cases with fresh fractures,9 cases with old fractures),45 cases of Hangman fracture(28 cases with fresh fractures,17 cases with old fractures),24 cases of torn transverse ligament of atlas,23 cases of congenital deformity,19 cases of unilateral fracture of vertebral arch of atlas,17 cases of rheumatoid arthritis,9 cases of unilateral fracture of articular process,3 cases of Jefferson fracture with chronic instability, 4 cases of spinal tumor. 29 cases were treated by odontoid screw fixation;10 cases treated by intervertebral fusion for C2-3;27 cases treated by atlantoaxial fusion followed with Apofix fixation;65 cases treated by occipitocervical fusion followed with fixation(29 cases with Axis,and 36 cases with Cervifix);32 cases treated by Atlantoaxial fusion and Simmons fixation;8 cases treated by Brooks fixation;8 cases treated by articular process screw fixation together with spinal wire;4 cases treated by compressed pedicle screw fixation and bone graft;1 case treated by other method. Results With a average follow-up of 4 years and 9 month,189 cases obtained bony union;3 cases were with delayed union;broken wire occurred in 2 cases;transposition of vertebral body for 1 case;vertebral arterial injury for 6 cases;nerve root injury for 12 cases;Screw back out for 10 screws. Improvement of JOA criteria was 79.9%;There were no deteriorations in spinal cord injury. Conclusion A proper surgical method is the essential treatment; a suitable fixator can decrease post-operative complications.