颈胸段脊柱骨折的手术治疗

The surgical therapy of cervicothoracic spinal fracture

目的:探讨颈胸段脊柱骨折合并脊髓损伤的手术治疗效果。方法:2005年1月至2011年1月,针对病情运用椎弓根螺钉技术,或(和)前路减压、植骨、钛板内固定技术治疗颈胸段骨折患者28例。术后3 d观察置入的椎弓根螺钉位置、钛笼植骨的愈合情况;统计患者术前与术后6个月JOA评分及ASIA分级改善情况。结果:共植入颈椎椎弓根螺钉72枚,胸椎椎弓根螺钉34枚,所有椎弓根螺钉位置合适,未见神经、血管受损表现。Ⅰ期后路椎弓根螺钉技术结合侧前路椎体次全切、钛笼椎间融合、钛板内固定术患者均获得骨性融合,融合时间为术后4～6个月,无置入物断裂、脱落等。肢体功能恢复平均为3.9个级别。结论:该技术治疗颈胸段骨折疗效好,但应熟知脊柱脊髓的解剖、熟练手术操作,减少手术创伤。

Objective：To discuss the treated effectiveness of surgery in cervico-thoracic fracture complicated with spinal cord injury. Methods： According to injuring status in twenty-eight patients with cervico-thoracic fracture, pedicle screw implantation or （and） an- terior titanium plate fixation,with decompression and bone graft,was （were） used to treat these patients from May 2005 to May 2011. The accuracy of the pedicle screws and the fusion of bone graft of titanium cage were evaluated by CT screening three days after surger- y. The recovery of spinal cord and nerve was evaluated by the score improvement of JOA and the classification diversity of ASIA six months after their surgery. Results： There were 72 pedicle screws in cervical vertebrae and 34 pedicle screws in upper thoracic verte- brae implanted successfully, without the injury of spinal cord or vertebral artery. The patients, with pedicle screw implantation or （and） anterior titanium plate fixation with decompression and bone graft, achieved bony fusion from four to six months after surgery, without any complications such as loosening and amotic of screws, abruption of titanium plate, etc. The functional recovery of spinal cord improved on the average 3.9 degree by ASIA standard. Conclusion： The curative effect can be reliable in the treatment of eervi- co-thoracic fractures, but the operator should be proficient with the local anatomy of eervico-thoracic spine and the techniques for im- plantation of pedicle screws, and decreasing surgery injury.