一期后路经关节螺钉联合前路钢板固定治疗下颈椎骨折脱位

摘要

Objective To evaluate the effects of one stage internal fixation with posterior transartitular screws and anterior plating for the treatment of lower cervical spine fractures and dislocations.Methods From October 2005 to May 2007, 12 patients with fractures and dislocations of lower cervical spine were treated by one stage anterior-posterior internal fixation. Posterior transarticular screw fixation combined with anterior decompression and bone graft and anterior plating were applied for only dislocations.Anterior decompression and bone graft and anterior plating combined with posterior transarticular screw fixation were applied for the fractures and dislocations. The zygapophysial joints were fused. Results All patients were followed up for 6 to 21 (average, 14. 8) months. No loosening of the transarticular screw or nerve-vessel complication was found. Intervertebral and zygapophysial joints all got bony healing. Conclusion One stage internal fixation with posterior transarticular screws and anterior plating is an ideal method of treating lower cervical fractures and dislocations, having the advantages of simple and safe procedures, reliable fixation and a high rate of bone fusion.%目的 探讨一期后路经关节螺钉联合前路钢板固定技术治疗下颈椎骨折脱位的效果. 方法 自2005年10月至2007年5月对12例下颈椎骨折脱位患者采用一期前后路联合手术.单纯脱位者,先行后路复位经关节突螺钉固定,再改行前路椎间隙减压,植骨融合,钢板内固定;椎体骨折伴脱位者,前路先行椎体次全切除,植骨融合,钢板内固定,然后行后路经关节螺钉固定脱位节段,小关节间行植骨融合.术前ASIA分级:A级21例,B级6例,C级3例,D级1例. 结果 12例患者获6～21个月(平均14.8个月)随访,椎间及小关节间植骨全部愈合.无螺钉松动及神经、血管并发症.术后除1例完全性瘫痪患者神经功能无恢复外,其余11例均有一级以上恢复.术后ASIA分级:A级1例,B级1例,C级4例,D级4例,E级2例. 结论 下颈椎经关节螺钉联合前路钢板固定融合术,具有操作简单安全、固定可靠、植骨融合率高等优点,是治疗下颈椎骨折脱位较为理想的术式.