CAJ | 학술논문

[目的]探讨寰枢椎椎弓根螺钉经后路固定融合治疗 Jefferson 骨折伴齿状突骨折的临床疗效。[方法]自2009年3月至2012年5月对12例Jefferson骨折伴枢椎齿状突骨折患者采用寰枢椎椎弓根螺钉经后路内固定融合术，齿状突骨折按Anderson分型：Ⅱ型9例，Ⅲ型3例；术前神经功能JOA 评分5～13（9．6±0．2）分。术前均行X线、螺旋三维CT及MRI等影像学检查及颅骨牵引术。比较术前和术后1年的JOA评分，并计算改善率。[结果]寰枢椎骨折脱位基本复位。术中无椎动脉损伤、脊髓及神经根损伤发生，术后无神经症状加重。随访6～18个月，平均13个月，临床症状得到显著改善；手术6个月后复查X线、螺旋C T示所有骨折均呈骨性愈合，螺钉位置良好，无松动、脱落、断裂。术后1年神经功能JOA 评分14～17（16．1±0．2）分，平均改善率为85．8％。[结论]寰枢椎椎弓根螺钉经后路固定融合治疗Jefferson 骨折伴齿状突骨折疗效显著，具有固定可靠，骨折愈合率高等优点。
[목적]탐토환추추추궁근라정경후로고정융합치료 Jefferson 골절반치상돌골절적림상료효。[방법]자2009년3월지2012년5월대12례Jefferson골절반추추치상돌골절환자채용환추추추궁근라정경후로내고정융합술，치상돌골절안Anderson분형：Ⅱ형9례，Ⅲ형3례；술전신경공능JOA 평분5～13（9．6±0．2）분。술전균행X선、라선삼유CT급MRI등영상학검사급로골견인술。비교술전화술후1년적JOA평분，병계산개선솔。[결과]환추추골절탈위기본복위。술중무추동맥손상、척수급신경근손상발생，술후무신경증상가중。수방6～18개월，평균13개월，림상증상득도현저개선；수술6개월후복사X선、라선C T시소유골절균정골성유합，라정위치량호，무송동、탈락、단렬。술후1년신경공능JOA 평분14～17（16．1±0．2）분，평균개선솔위85．8％。[결론]환추추추궁근라정경후로고정융합치료Jefferson 골절반치상돌골절료효현저，구유고정가고，골절유합솔고등우점。
[Objective] To explore clinical outcome of atlantoaxial pedicle screw via posterior fixation and infusion for the treatment of Jefferson fracture associated with odontoid fracture .[Methods] A total of 12 pa-tients with Jefferson fracture and odontoid fracture from March 2009 to May 2012 underwent atlantoaxial pedi-cle screw via posterior fixation and infusion .All patients were 8 males and 4 females with a mean age of 40 .3 years old(ranged 25 to 62 years old) .According to Anderson classification ,there were 9 patients with type II odontoid fracture and 3 patients with type III odontoid fracture .Preoperative JOA score of neurological func-tion were from 5~13(means 9 .6 ± 0 .2) .Before the operation ,the imaging examinations such as X-ray ,spiral 3-dimension CT and MRI and skull traction were performed .JOA scores were compared between before and one year after operation .The improvement rate was calculated .[Results]Atlantoaxial fracture dislocation a-chieved basic reduction .No vertebral artery injury ,spinal and nerve root injury occurred during the operation . No deterioration of spinal cord injury was observed after operation .All patients were followed up for 6~18 months(mean 13 months) .Clinical symptoms were improved significantly .Reexamination of X-ray and spiral CT 6 months after operation showed that all fractures were bone union .The screw position was good .No loosening ,defluxion and breaking occurred .JOA scores of neurological function one year after operation were 14~17(mean 16 .1 ± 0 .2) .The average improvement rate was 85 .8% .[Conclusion]Atlantoaxial pedicle screw via posterior fixation and infusion for the treatment of Jefferson fracture associated with odontoid fracture has significant efficacy .It is advantages such as stable fixation and high bone union rate .