目的：探讨颈后路椎弓根钉棒系统治疗成人创伤性寰枢椎脱位近期临床疗效。方法：选择2009年1月-2012年12月本院骨科收治的外伤性寰枢椎脱位的患者32例，其中男20例，女12例，年龄33~48岁，平均41.2岁，神经损伤20例，ASIA分级：B级5例，C级9例，D级6例。术前均行X线及CT扫描检查，入院后立即给予颅骨牵引。手术采用后路椎弓根钉棒系统固定，寰椎后弓及枢椎椎板间植骨融合，观察近期临床疗效。结果：32例手术顺利。随访时间13~33个月，平均随访19个月，无一例失访。术后所有患者临床症状均得到改善，临床疗效：优22例，良10例。20例神经损伤患者得到明显恢复，术后ASIA分级：B级1例，C级2例，D级5例，E级12例。植骨达骨性融合，无钉棒松动、断裂。术后6个月JOA评分与术前评分对比，显著提高（t=3.179，P<0.05）。结论：颈后路椎弓根钉棒系统治疗成人创伤性寰枢椎脱位固定牢固可靠，植骨融合率高，有助于寰枢椎稳定性重建和神经功能恢复。%Objective:To explore the clinical effect of posterior cervical pedicle screw system in the treatment of adult traumatic atlantoaxial dislocation.Method:32 patients in orthopedics department of our hospital with traumatic atlantoaxial dislocation were observed from January 2009 to December 2012,including 20 male cases,12 female;age 33-48 years, mean age 41.2 years;20 cases were combined with nerve injury ASIA classification:5 cases of grade B,9 cases of grade C,6 cases of grade D.All the patients underwent X-ray and CT scan and skull traction immediately after admission.Operation was posterior pedicle screw-rod system fixation,posterior arch of atlas and the lamina of axis interbody fusion.The recent of clinical efficacy were observed.Result:32 patients underwent the operation successfully.The follow-up period ranged from 13 to 33 months,average 19 months follow-up,no patients was lost to follow-up.Clinical symptoms of all patients were improved,the clinical curative effect,excellent in 22 cases, good in 10 cases.20 cases of patients with nerve injury had recovered.Postoperative ASIA grade:1 case of B grade,2 cases of C grade,5 cases of D grade,12 cases of E grade.Bone fusion was obtained,there was no screw loosening and fracture.The JOA score of patients 6 month later was significant higher than before the operation.Conclusion:Posterior pedicle screw system in the treatment of adult traumatic atlantoaxial dislocation fixation is firm and reliable,with high rate of bone graft fusion,help atlantoaxial stability reconstruction and recovery of neurological function.
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