不同术式治疗上颈椎不稳定损伤疗效观察

Treatment of the upper cervical spine instability injury by different surgical techniques

目的探讨应用不同术式治疗上颈椎不稳定型损伤的疗效。方法对36例上颈椎不稳定损伤病人行单纯头环背心（Halo—vest）固定术11例；行Halo-vest固定下的后路颗粒状松质骨植骨融合术15例；行Halo-vest＋Gallie术式＋颗粒状松质骨植骨融合术3例；行内固定加植骨融合术7例。结果随访3～32个月（平均18个月），植骨融合，无内固定物折断、松脱，无1例出现神经血管损伤症状。结论上颈椎不稳定型损伤的治疗方法较多，针对病人的具体情况选择不同的治疗方案，只要解除了对脊髓的压迫，稳定了损伤的颈椎椎体，就可达到满意的治疗效果。

Objective To assess the therapeutic effect of differentsurgical management in treating upper cervical vertebra injuries. Methods Of 36 patients suffered from upper cervical vertebra injuries, 11 were treated by Halo-vest external fixation, 15 were treated by Halo-vest external fixation and posterior cancellated bone graft fusion, 3 were treated by Halo - vest external fixation and Gallie technique and cancellated bone graft fusion,7 were treated by Halo - vest external fixation with internal fixation and bone graft. Results During a 3 to 32 months （ averaged 18 months}follow-up study,bone union was obtained. No breakage of internal fixation material was found. The fixation material did not come loose. All the patients had no symptoms of injury of nerve and blood vessel. Conclusion The surgical management for upper cervical vertebra unstable injuries are various. However, a treatment individualized according to the patients＇clinical condition can result in a satisfied therapeutic effect as long as the compression on the spine had been reliefed and the injuried cervical vertebra had been stabilized.