寰枢椎椎弓根螺钉经后路固定融合治疗 Jefferson 骨折伴齿状突骨折

Atlantoaxial Pedicle Screw via Posterior Fixation and Fusion for the Treatment of Jefferson Fracture

[目的]探讨寰枢椎椎弓根螺钉经后路固定融合治疗 Jefferson 骨折伴齿状突骨折的临床疗效。[方法]自2009年3月至2012年5月对12例Jefferson骨折伴枢椎齿状突骨折患者采用寰枢椎椎弓根螺钉经后路内固定融合术，齿状突骨折按Anderson分型：Ⅱ型9例，Ⅲ型3例；术前神经功能JOA 评分5～13（9．6＆#177;0．2）分。术前均行X线、螺旋三维CT及MRI等影像学检查及颅骨牵引术。比较术前和术后1年的JOA评分，并计算改善率。[结果]寰枢椎骨折脱位基本复位。术中无椎动脉损伤、脊髓及神经根损伤发生，术后无神经症状加重。随访6～18个月，平均13个月，临床症状得到显著改善；手术6个月后复查X线、螺旋C T示所有骨折均呈骨性愈合，螺钉位置良好，无松动、脱落、断裂。术后1年神经功能JOA 评分14～17（16．1＆#177;0．2）分，平均改善率为85．8％。[结论]寰枢椎椎弓根螺钉经后路固定融合治疗Jefferson 骨折伴齿状突骨折疗效显著，具有固定可靠，骨折愈合率高等优点。

[Objective] To explore clinical outcome of atlantoaxial pedicle screw via posterior fixation and infusion for the treatment of Jefferson fracture associated with odontoid fracture .[Methods] A total of 12 pa-tients with Jefferson fracture and odontoid fracture from March 2009 to May 2012 underwent atlantoaxial pedi-cle screw via posterior fixation and infusion .All patients were 8 males and 4 females with a mean age of 40 .3 years old（ranged 25 to 62 years old） .According to Anderson classification ,there were 9 patients with type II odontoid fracture and 3 patients with type III odontoid fracture .Preoperative JOA score of neurological func-tion were from 5~13（means 9 .6 ＆#177; 0 .2） .Before the operation ,the imaging examinations such as X-ray ,spiral 3-dimension CT and MRI and skull traction were performed .JOA scores were compared between before and one year after operation .The improvement rate was calculated .[Results]Atlantoaxial fracture dislocation a-chieved basic reduction .No vertebral artery injury ,spinal and nerve root injury occurred during the operation . No deterioration of spinal cord injury was observed after operation .All patients were followed up for 6~18 months（mean 13 months） .Clinical symptoms were improved significantly .Reexamination of X-ray and spiral CT 6 months after operation showed that all fractures were bone union .The screw position was good .No loosening ,defluxion and breaking occurred .JOA scores of neurological function one year after operation were 14~17（mean 16 .1 ＆#177; 0 .2） .The average improvement rate was 85 .8% .[Conclusion]Atlantoaxial pedicle screw via posterior fixation and infusion for the treatment of Jefferson fracture associated with odontoid fracture has significant efficacy .It is advantages such as stable fixation and high bone union rate .