前路术式治疗高位颈椎损伤的疗效观察

Observation of the anterior surgery treatment effect on high cervical spine trauma

目的 探讨前路术式治疗高位颈椎损伤的临床疗效。方法搜集我院2006年-2010年高位颈椎损伤患者7例，男5例，女2例，年龄23～62岁。其中，齿状突骨折3例，齿状突骨折伴寰枢椎脱位4例。本组采用经颈前入路松解复位，中空螺钉内固定术治疗齿状突骨折。结果全部病例得到随访，时间6个月-4年，本组通过高位前入路显露完成内固定置入，无1例舌下神经、颈动脉分支、颈动脉鞘和喉上神经损伤以及咽后壁损伤，对术后颈椎生理旋转功能影响较小，无椎动脉和脊髓损伤，术后患者神经症状明显缓解。结论采用经颈前路中空螺钉内固定手术治疗齿状突骨折并寰枢关节脱位能明显改善高位颈椎的稳定性，固定确切，不影响c1、c2活动，且并发症少，临床效果满意。目前治疗高位颈椎损伤手术方式众多，各有其优点及缺点，选择不一样的术式需根据患者损伤特点及是否椎体间脱位，严格把握适应症，在解除症状的前提下给予稳定固定和不影响关节的活动。

Objective To explore the anterior surgery treatment effect on high cervical spine trauma. Methods Collected 7 patients who were in our hospital, 5 males and 2 females, aged from 23 to 62 years, with high cervical injury, from 2006 to 2010; among them, 3 cases had odontoid fractures, 4 cases had odontoid fractures with atlantoaxial dislocation. The group were reset by releasing anterior cervical approach, and cannulated screw fixation of odontoid fractures. Results All patients were followed for 6 months to 4 years; the group adopted high anterior approach to expose the complete fixation placement had no case of hypoglossal nerve, carotid artery, carotid sheath, superior laryngeal nerve injury, and posterior wall injury of pharynx; after the operation, it had little influence on cervical rotation, and didn＇ t have vertebral artery and spinal cord injury; what＇ s more, neurological symptoms were obviously relieved after surgery. Conclusion The anterior cannulated screw fixation of odontoid process fracture and dislocation of atlantoaxial joint can improve the stability of high cervical spine, has exact fixation, does not affect the activities of C 1 and C2, has fewer complications, and whose clinical results were satisfactory. Currently, there are many surgical treatments of high cervical injury; each has its own advantages and disadvantages; choosing a different surgical treatment should base on the injury characteristics of patients and whether the patients have vertebrae dislocation ; except that, also should strictly control its indication, and give the patients stable fixation and tell them to do some exercise not affecting the joint before the relieving of the symptoms.