颈后路手术治疗上位颈椎不稳定型损伤

Posterior Surgical Approach for Operation of Upper Cervical Spine Unstable Injuries

目的:探讨上颈椎不稳定损伤后路手术方法及其疗效。方法:59例中,采用枕颈融合术27例,其中辅以CD-Cervical或Cervifix内固定11例;实施寰枢椎融合术29例,其中7例行C1/2侧块关节螺钉固定,8例行Apofix椎板夹固定;进行C_(2、3)椎板、棘突间植骨Axis内固定3例,均为Hangman氏骨折。结果:51例获随访,平均3.5年。骨性愈合47例,不愈合4例。术前合并神经系统症状29例,术后症状消失和明显改善共22例,加重1例。结论:对于上颈椎不稳定型损伤应早期进行植骨内固定,认真准备植骨床和可靠的内固定是保证手术成功的关键。

Objective: To investigate the results of operative treatment of upper cervical spine unstable injuries through pos- ' tenor approach. Methods: All of the 59 patients were treated by operation. Occipitocervical fusion were performed in 27 patients, CD - cervical or Cervifix fixation were used in 11 patients;29 patients were operated upon by arthrodesis simple with autologous bone grafts,7 patients added atlantoaxial facet screw fixation. Eight patients were operated on by atlantoaxial arthrodesis using Apofix interlaminar clamping with autologous bone grafts. Three patients of Hangman's fracture were operated upon by C2-3 fusion using Axis internal fixations. Results: Fifty-one patients were followed up for an average of 3. 5 years (ranged 4 - 72 months). Solid arthrodesis were obtained in 47 patients and nonunion in 4 cases. The patients with nerve injury in pre-operation were 29 cases. One case was worse after the operation. Conclusion: Posterior fusion is recommended for upper unstable cervical spine due to traumatic fracture or ligament disruption. It is emphasized that seriously preparing the fusion bed,reliable internal fixation are the important measures for successful operation.