后路寰椎钉板系统内固定治疗不稳定型Jefferson骨折

Posterior pedicle screw-plate system for unstable Jefferson fracture

目的：探讨后路钉板系统单纯寰椎内固定治疗不稳定型Jefferson骨折的可行性及临床疗效。方法：2005年2月一2009年10月共收治外伤后不稳定型Jefferson骨折患者10例，男7例，女3例，均有枕颈部疼痛及活动受限，术前VAS评分平均7．5分，4例伴随脊髓功能损伤表现，Frankel分级C级1例，D级3例。均采用后路钉板系统单纯经寰椎椎弓根固定治疗，随访观察临床疗效、骨折复位及稳定性、手术并发症等情况。结果：手术时间70-120min，平均90min；术中出血110-300ml，平均200ml，无脊髓损伤、硬膜破裂及椎动脉损伤等并发症。患者枕颈部疼痛均明显减轻，术后VAS评分平均2．1分；伴脊髓损伤患者神经功能均恢复正常；影像学复查示所有患者达解剖复位，螺钉位置良好。随访8-48个月，平均25个月，患者寰椎骨折均骨性愈合，平均愈合时间为6个月。患者颈部的前屈与后伸35°-42°，平均38°；左右旋转60°-73°，平均66°；左右侧屈40°-45°，平均42°，颈椎活动度接近正常。结论：后路钉板系统单纯寰椎椎弓根内固定治疗不稳定型Jefferson骨折具有复位效果好、融合率高、寰枢椎活动度保留完整、手术并发症少等特点，为Jefferson骨折的治疗提供了一种新的术式。

Objectives： To investigate the feasibility and the clinical outcome of posterior pedicle screw-plate system for unstable Jefferson fracture. Methods： From February 2005 to October 2009, 10 patients suffering from traumatic unstable Jefferson fracture underwent posterior instrumentation by pedicle screw-plate system. Among them there were 7 males and 3 females, all cases presented with neck pain and limit of cervical range of motion（ROM）, the preoperative average visual analogue score（VAS） was 7.5. 4 cases suffered from neurological deficit, including 1 Frankel C and 3 Frankel D. After surgery, the clinical efficacy, reduction and stability, surgical complications were reviewed retrospectively. Results： The average operative time was 90min （range, 70-120min）, and the average blood loss was 200ml（range, 110-300ml）. The complications including spinal cord injury, dural matter tear and vertebral artery injury did not occur. The neck pain relief was achieved. The average postoperative VAS was 2.1, and neurofunction returned to normal. The radiograph con- firmed anatomic reduction and well placement of screw. All cases were followed up for 8-48 months（average, 25 months）, and all cases had bony union with a mean time of 6 months. The ROM of cervical spine was 350-42°for flexion-extension（average, 38°）, 600-73°for rotation（average, 66°） and 400-45°for lateral bending （average, 42°）, with the cervical ROM returning to normal. Conclusions： Posterior pedicle screw-plate system for unstable Jefferson fracture is reliable, with high fusion rate and less complication, which can be used as an alternative to conventional approachs.