摘要
目的探讨颈椎后路手术治疗齿状突骨折及其邻近节段损伤的临床疗效。方法 2009-08-2013-08 21例齿状突及其邻近节段骨折脱位在我院行颈椎后路手术治疗患者。21例均采用上颈椎后路个性化的固定方式。随访观察患者临床症状和神经功能改善情况,对有脊髓损伤的患者,术前、术后6个月进行JOA评分,术后随访影像学资料评价骨折愈合、植骨融合等情况。结果所有病例术后均获得随访,平均随访时间18个月（12~48个月）,术中未出现脊髓、椎动脉损伤等严重并发症。术后6个月临床症状得到明显改善,X线片示螺钉位置良好,无松动、断钉,所有骨折均呈骨性愈合。9例不完全性脊髓损伤患者术后脊髓神经功能ASIA分级均较术前提高,脊髓功能均获不同程度改善。JOA评分从术前平均（11.4-2.6）分提高至术后6个月平均（15.1-2.9）分,术前术后比较有统计学差异,平均改善率为（85.3%±8.3%）,优良率95%。结论选择合理的颈椎后路手术方式,在治疗齿状突骨折及其邻近节段损伤中,能取得良好的疗效。
Objective To explore the clinical outcome of the posterior approach surgical treatment for odontoid process fracture of dens combined with nearby structure injuries. Methods 21 cases who sustained fracture of odontoid process combined with nearby structure injuries were admitted in our hospital from August 2009 to August 2013. There were 13 men and 8 women, aged from 19 to 70 years （average 39.9 years old）. There were 5 cases of simple odontoid fractures and 16 cases of odontoid fractures with adjacent segment trauma. The ASIA scale was used to assess nerve function （n=9）. There were grade C（n=4） and grade D （n=5）at preoperation. Different posterior approach surgical treatments were used to reduce fractures and stabilize upper cervical vertebrae. The Japanese Orthopedic Assiociation （JOA） standards were used to evaluate the therapeutic effect. According to JOA grade,nerve functional restoration of spinal cord injury was gauged. Atlanto axial reduction,fracture healing and bone graft fusion were monitored by radiology or computed tomography. Results All cases were regularly followed up. The duration of follow-up was 18 months on average （ranged 12~48 months）. All patients were operated successfully and no severe complications such as cord or vertebral artery injury occurred. A follow-up in all patients showed that the clinical symptom was improved significant- ly postoperative six months and the surrounding fractures and dislocation were all healed. There was no screw-rod breakage in atlanto-axial region. The spinal function got improved in 9 pa- tients,the preoperative mean scores of JOA was （11.4±2.6）,and the JOA scores of postoperative 6 months was （15.1±2.9）,the mean improvement rate was （85.3±8.3）%,with good and excellent rate of 95%. There was statistically significant difference in JOA scores between pre-operation and post- operation （P 〈 0.05）. Conclusion The appropriate posterior approach surgical treatment for odontoid process fracture of dens combined with nearby structure injuries can provide a satisfied result.
出处
《颈腰痛杂志》
2015年第2期115-118,共4页
The Journal of Cervicodynia and Lumbodynia
关键词
颈椎
骨折
脱位
手术治疗
cervical spine
fracture
dislocation
surgical operation
