颈椎椎弓根螺钉内固定治疗外伤性颈椎骨折脱位的临床观察

Clinical Observation of Pedicle Screw Internal Fixation for the Treatment of Traumatic Cervical Spine Fracture and Dislocation

【目的】探讨颈椎椎弓根螺钉内固定治疗外伤性颈椎骨折脱位的临床疗效。【方法】自2007年1月至2009年12月采用颈椎椎弓根内固定治疗颈椎骨折脱住28例。损伤部位：C16例，C22例，C1～4 3例，C4 3例，C5 4例，C5～6 5例，C63例，C6～7 2例。脱位程度：I度脱位20例，Ⅱ度脱位5例，Ⅲ度脱位l例，Ⅳ度脱位2例。A—SIA分级：A级3例，B级1例，C级3例，D级4例，E级17例。全部病例术前均行X线、CT及MRI检查并根据其结果行个体化椎弓根钉置入。术前和术后按ASIA神经功能评估方法评价手术疗效。【结果128例均获得8～18个月随访，平均随访12个月，随访期内无一例死亡。其中置入螺钉140枚，有128枚位置正确，12枚存在不同程度偏差，无手术相关并发症，无神经损伤加重。AsIA分级：A级3例中的1例恢复至D级，2例恢复至B级，B级1例恢复至C级，C级3例中的1例恢复至D级，2例恢复至E级，D级4例恢复至E级，E级17例仍为E级。【结论】颈椎椎弓根钉内固定是治疗外伤性颈椎骨折脱位安全有效。

[Objective]To explore the clinical efficacy of pedicle screw internal fixation for the treatment of traumatic cervical spine fracture and dislocation. [MethodslTotally 28 patients with cervical spine fracture and dis- location from Jan. 2007 to Dec. 2009 underwent pedicle screw internal fixation. According to the injury position, there were 6 patients at C1, 2 patients at C2, 3 patients with C3-4, 3 patients at C4, 4 patients at C5, 5 patients at Cs-6, 3 patients at C6 and 2 patients at C6-7. According to the degree of dislocation, there were 20 patients with degree I, 5 patients with degree 11 , 1 patient with degree I]I and 2 patients with degree IV. According to ASIA classification, there were 3 patients with grade A, 1 patient with grade B, 3 patients with grade C, 4 patients with grade D and 17 patients with grade E. All patients received X-ray, CT and MRI examinations before operation. Based on the imaging results, individualized pedicle screws were implanted. Preoperative and postoperative ASIA neurological function assessment method was used for evaluating the surgical efficacy. [Results]All the 28 cases were followed up from 8 to 18 months with the average of 12 months. No death occurred during the follow up. A- mong 140 screw implants, 128 screws were in correct position and 12 screws were deviation. No operation compli- cation was found. There was no deterioration of neurological injury. According to ASIA classification, among 3 patients with grade A, 1 patient recovered to grade D and 2 patients recovered to grade B, and 1 patient with grade B recovered to grade C. Among 3 patients with grade C, 1 patient recovered to grade D, and 2 patients recovered to grade E. Four patients with grade D recovered to grade E. Seventeen patients with grade E were still grade E. [Conclusion] Pedicle screw internal fixation for the treatment of traumatic cervical spine fracture and dislocation is a safe and effective method.