单纯后路椎弓根钉内固定治疗下颈椎骨折脱位

The posterior approach combined with pedicle screw fixation for the treatment of lower cervical fractures and dislocation

目的探讨单纯后路应用椎弓根钉内固定治疗下颈椎骨折脱位的可行性。方法回顾性分析2010年1月至2012年12月采用一期单纯后路椎弓根钉内固定治疗30例下颈椎骨折脱位患者资料，男22例，女8例；年龄24-61岁，平均41岁；C4.5骨折伴脱位8例，C5.6骨折伴脱位12例，C6.7骨折伴脱位10例。ASIA脊髓损伤分级：A级8例，B级12例，C级5例，D级3例，E级2例。结果所有颈椎骨折脱位均获得良好复位和固定，共成功置入140枚颈椎弓根螺钉，术后x线及CT三维重建示螺钉位于椎弓根内。术后随访3-23个月，平均11个月。术后ASIA脊髓损伤分级，8例仍为A级，但截瘫平面下降，运动感觉好转；10例B级提高至C级；其余患者保持或提高至E级。所有病例均获良好骨性融合，无一例发牛脱钉、断钉、断棒等并发症。术后2周及3个月复查颈椎MRI均未见颈椎间盘后移、突出及压迫脊髓。结论对于下颈椎骨折脱位伴难复性关节突绞锁、椎间盘破裂的患者，单纯后路复位，并以椎弓根螺钉固定能三维固定损伤节段，力学强度足够，安全有效；术中运用正确的纵向牵伸技术，能有效解锁并复位，可防止椎间盘后移及加重脊髓损伤。

Objective To evaluate the feasibility of using the posterior approach with cervical pedicle screw fixation technique for the treatment of lower cervical spine fractures and dislocations. Methods Thirty patients suffered lower cervical fractures and dislocations were retrospectively analyzed, and they were underwent cervical pedicle screw system fixation surgery from January 2010 to December 2012. There were 22 males and 8 females, with an average age of 41 years （range, 24-61 years）. Eight injuries were located at Ca, 5, 12 at C5, 6, and 10 at C6. 7- According to the American Spinal Cord Injury Association （ASIA） impairment scale, 8 cases were grade A, 12 were grade B, 5 were grade C, 3 were grade D, and 2 were grade E. Results Re- duction and fixation of the injured segments were performed via a posterior approach in all 30 patients. One hundred and forty pedicle screws were inserted successfully in all patients on the postoperative radiographic and CT scans. All the patients were followed up for 3-23 months, with the average of 11 months. According to the ASIA impairment scale, eight cases with grade A were still grade A, but the feeling and movement improved obviously. Ten grade B improved to grade C and the rest cases were complete recovery after operations. During the course of the follow up, solid bone union was achieved in all patients, and there were no hardware failures. All the patients＂ postoperative MRI showed disappearance of the spinal cord compression after reduc- tion in all cases. Conclusion For the patients of lower cervical fractures and dislocation, the first choice of operation should be the posterior approach reduction and fixation with cervical pedicle screw. The correct lengthwise traction method could unblock the locked facet effectively, and prevent the rctrusion of disc and the further injury of spinal cord. For the patients of disc disrup- tion, the posterior approach could be used only. The cervical pedicle screw system could provide three-dimensional reduction of the injured cervical segments and the adequate mechanical strength. The posterior approach combined with pedicle screw fixation is feasible and effective for the treatment of lower cervical fractures and dislocation.