摘要：
Objective To investigate the clinical efficacy of posterior screw-rod single vertebra internal fixation for anterior atlas arch displaced fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 13 patients with anterior atlas arch displaced fracture admitted to Henan Provincial People's Hospital from January 2010 to March 2016.There were eight males and five females,aged 28-62 years[(40,0±9.2)years].According to Frankel grading,there was one patient with grade C and 12 patients with grade D.All patients were treated with posterior cohesive reduction with screw-rod system.Operation time,blood loss,intraoperative and postoperative complications were recorded.The operation time,intraoperative blood loss,internal fixation position,fracture healing and bone graft fusion were recorded.The Japanese orthopedic- association(JOA)score,visual analogue scale(VAS),Frankel grade,and cervical motion range were compared before and at the last follow-up.The intraoperative and postoperative complications were recorded.Results All patients were followed up for 29～68 months[(48.2±14.5)months].The operation time was 50-75 minutes[(59.5±6.5)minutes],and blood loss was 55-80 ml[(62.5±8.3)ml].After operation,fracture lines were well reset,nerve compression was relieved,pillow neck pain was alleviated,and limb function was significantly improved.CT scans confirmed bony union in al 1 patients 6 months after operation.The JOA score at the last follow-up[(15.4±0.7)points]was significantly higher than that before operation[(7.9±1.3)points](P＜ 0.05).The preoperative VAS was significantly decreased from(6.2±0.9)points to(1.9±1.0)points at the last follow-up(P＜ 0.05).The range of motion of cervical spine was close to the normal level with 70°-91°[(80.7±7.0)°]of anteflexion and extension,131°-157°[(142.9±9.1)°]of horizontal rotation,and 78°-89°[(83.8±3.2)°]of lateral flexion.One patient with incision infection and five neck stiffness as well as limited neck movement were reported,but all were cured or improved significantly after symptomatic treatment.No internal fixation lossening or breakage was found.Conclusions Posterior screw-rod single vertebra internal fixation for anterior atlas arch displaced fracture has the advantages of shortened operation time,less bleeding,less complication,good reduction as well as restored motor function of atlantoaxial joint.%目的 探讨后路钉棒单椎节内间定治疗前弓分离移位型寰椎骨折的临床效果.方法 采用冋顾性病例系列研究分析2010年1月-2016年3月河南省人民医院收治的13例前弓分离移位型寰椎骨折患者的临床资料,其中男8例,女5例;年龄28～62岁[(40.0±9.2)岁].Frankel分级:C级1例,D级12例.患者均行后路寰椎钉棒系统内聚复位术治疗.记录手术时间、术中出血量,观察骨折愈合情况,比较术前和末次随访时颈椎日本骨科学会(JOA)评分、视觉模拟评分(VAS)、Frankel分级及颈椎活动度,观察术中及术后并发症情况.结果 患者均获随访29～68个月[(48.2±14.5)个月].手术时间50～75min[(59.5±6.5)min].术中出血量55～80ml[(62.5±8.3)ml].术后骨折线均获良好复位,术后6个月患者获骨性愈合.JOA评分由术前的(7.9±1.3)分提高至末次随访时的(15.4±0.7)分(p＜0.05).VAS由术前的(6.2±0.9)分下降至末次随访时的(1.9±1.0)分(P＜0.05).Frankel分级均为E级.末次随访时颈部屈伸70°～91°[(80.7±7.0)°],左右旋转131°～157°[(142.9±9.1)°];左右侧屈78°～89°[(83.8±3.2)°],颈椎活动范围基本接近正常水平.1例切口感染,5例枕颈部僵硬并活动受限,均经对症治疗痊愈或明显好转.未出现内固定松动、断裂等并发症.结论 后路钉棒单椎节内固定治疗前弓分离移位型寰椎骨折,手术时间短,术中出血量少,手术并发症少,可获得良好复位,寰枢关节运动功能和颈椎屈伸功能均得到保留.
