摘要目的 探讨颈后路单侧螺钉短节段固定植骨融合术治疗特殊类型上颈椎损伤患者的临床疗效.方法 采用回顾性病例系列研究分析2012年7月-2017年5月山西白求恩医院收治的 15例上颈椎损伤患者临床资料,其中男 9例,女 6例;年龄 10～69 岁[(41.9±20.9)岁].创伤性寰枢椎脱位 8例,先天性寰枢椎脱位 1例,寰枢推脱位合并齿突不连 2 例,Anderson Ⅱ型齿突骨折 3例,陈旧性齿突骨折 1例.患者均有不同程度颈枕部疼痛及单侧椎弓根纤细、椎动脉明显狭窄.患者均采用颈后路单侧螺钉短节段固定植骨融合术治疗.记录术中脊髓和椎动脉损伤情况、手术时间和术中出血量.术前和术后采用视觉模拟评分(VAS)评价疼痛情况,术前和末次随访采用日本骨科学会(JOA)评分评估患者脊髓功能和术后改善率.术后复查 X线片观察内固定位置、植骨融合情况.结果 15例患者均获随访 6～36个月[(20.4±8.6)个月].螺钉均一次性成功置入,术中未发生脊髓或椎动脉损伤.手术时间 100～210 min[(131.3±32.0)min],术中出血量100～450 ml[(203.1±104.0)ml].术前 VAS为(7.9±0.9)分,术后为(3.7±0.8)分(P＜0.01).术前 JOA评分为(12.1±4.4)分,末次随访时为(16.1±1.4)分(P＜0.05),术后 JOA改善率为68％.术后X线片显示颈椎序列恢复良好.1例术后 1个月去除颈围保护后发生内固定松动,及时行二次手术固定再融合后未再发生相关情况,其余 14例均未发生内固定松动、断裂或复位丢失,术后 6-12个月均骨性融合.结论 颈椎后路单侧螺钉短节段固定+植骨融合术能够重建颈椎的稳定性,缓解疼痛,促进功能恢复,可作为一种补充手术治疗解剖结构变异的上颈椎损伤.

abstractsObjective To investigate the clinical effect of posterior unilateral short segment screw fixation and bone graft fusion in the treatment of special upper cervical spine injuries.Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with upper cervical spine injury adrnitted to Shanxi Bethune Hospital from July 2012 to May 2017.There were nine males and six females,aged 10-69 years [(41.9±20.9)years].There were eight patients with traumatic atlantoaxial dislocation,one with congenital atlantoaxial dislocation,two with atlantoaxial dislocation with nonunion of odontoid process,three with Anderson type Ⅱ odontoid process fracture,and one with old odontoid process fracture.All patients had cervico-occipital pain to different degrees,slender unilateral pedicle and distinct stenosis of vertebral artery.All patients were treated with posterior unilateral screw fixation and bone graft fusion.The injury of spinal cord and vertebral artery,operation time and intraoperative blood loss were recorded.Visual analogue scale(VAS)was used to evaluate pain before and after operation,and Japanese Orthopaedic Association(JOA)score was used to evaluate spinal cord function and postoperative improvement rate before and at the last follow-up.The position of internal fixation and fusion of bone graft were ohserved by X-ray after operation.Results All 15 patients were followed up for 6-36 months [(20.4±8.6)months].All the screws were implanted successfully at the first time.Without spinal cord or vertehral artery injury.The operation time was 100-210 minutes [(131.3±32.0)minutes],and the intraoperative blood loss was 100-450 ml [(203.1±104.0)ml].Preoperative VAS score was(7.9 ±0.9)points.And postoperative VAS score was(3.7 ±0.8)points(P＜0.01).Preoperative JOA score was(12.1±4.4)points.And the JOA score at postoperative follow-up was(16.1±1.4)points.With the improvement rate of 68％.Postoperative X-ray showed good recovery of cervical spine sequence.One patient developed loosened internal fixation after the neck hrace protection was removed one month after surgery.And the patient recovered after timely second surgical fixation and fusion.The remaining 14 patients did not have loosened internal fixation.Fracture or loss of reduction.With bone fusion 6-12 months after surgery.Conclusion Posterior cervical unilateral short-segment screw fixation and bone graft fusion can restore cervical stability,relieve pain,and improve function recovery,which can he used as complementary procedure to treat upper cervical spine injury with anatomic structure variation.