外伤性颈椎骨折脱位的颈椎椎弓根螺钉内固定治疗及其临床疗效分析

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：回顾性分析2010年6月至2012年7月我院采用颈椎椎弓根内固定治疗颈椎骨折脱位28例。损伤部位：C16例，C22例，C3～43例，C43例，C54例，C5～65例，C63例，C6～72例。脱位程度：I度脱位20例，II度脱位5例，III度脱位1例，Ⅳ度脱位2例。ASIA分级：A级2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：28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 ofpedicle screw internal fixation for the treatment of traumatic cervical spine fracture and dislocation. Methods： Totally 28 patients with cervical spine fracture and dislocation from July 2010 to June 2012 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 C4, 4 patients C5, 5 patients at C5 -6, 3 patients at C6 and patients at C6-7. According to the degree of dislocation. there were 20 patients with degree I, 5patients with degree II, I patient with degree III and 2 patients with degree IV, according to ASIA classification, there were 3 patients with grade A, I 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, Postoperative ASIA neurological function assessment method was used for evaluating the surgical efficacy. Results： All the 28 cases were followed up from 8to 18 months with the average of 12 months. No death occurred during the follow up, among 140 screw implants, 128 screws were in correct position and 12 screws were deviation. No operation complication was found, there was no deterioration of neurological injury.According to ASIA classification among 3 patients with grade A, I patient recovered to grade D and 2 patients recovered to grade B, and I patient with grade B recovered to grade C, among 3 patients with grade C, I 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 spine fracture and dislocation is a safe and effective method.