创伤性上颈椎不稳的修复重建

Repair and re-establishment to traumatic upper cervical instability

目的:总结和分析19例创伤性上颈椎不稳的治疗效果,并对治疗方式以及疗效分析进行研究。方法:外伤患者19例,男16例,女3例;年龄21～56岁;包括寰椎骨折3例,齿突骨折10例,枢椎椎弓根骨折3例,寰枢椎半脱位3例,其中6例(单纯齿突骨折1例,寰椎骨折合并齿突骨折1例,枢椎椎弓根骨折1例,寰枢椎半脱位3例)选择非手术治疗,其余13例均采用手术治疗。结果:19例经随访6个月～6年,平均随访1.8年,根据JOA评分标准,非手术和手术患者术后改善率分别为42.5%和87.0%。结论:创伤性上颈椎不稳应早期诊断早期治疗,在选择术式时应保证上颈椎充分固定的同时尽量保留颈椎的功能,而且上颈椎的确切融合对远期疗效起决定性作用。

Objective：To summarize and analyze the therapeutic effect of traumatic upper cervical instability and investigate therapeutic methods and effect. Methods：There were 19 patients with traumatic upper cervical instability（male 16,female 3）,aged from 21 to 56 years,included 3 cases of atlas fracture,10 cases of dens fracture,3 cases of axis pedicle fracture, 3 cases of atlanto-axial subluxation. Among them,6 cases included 1 case of dens fracture, 1 case of dens fracture affiliated with atlas fracture,1 case of axis pedicle fracture,3 cases of atlanto-axial subluxation were treated conservatively and the other 13 cases were treated by operations. Results：Nineteen cases were followed up for 1.8 years in average（6 months to 6 years）. According to JOA standard for evaluation, the rate of improvement was 42.5% and 87.0% for conservative treatment and operation respectively. Conclusion：Traumatic super cervical unsteadiness should be diagnosed and treated early. Under the condition of upper cervical vertebra being completely fixed,the function of cervical vertebra to maximum extent could be reserved when choosing operation method. Especially,the precise fusion of upper cervical vertebra plays a vital role of long-term efficacy.