目的 探讨一期后路寰枢椎固定融合治疗不稳定寰椎爆裂性骨折的临床疗效.方法 回顾性分析2010年5月至2013年12月收治32例不稳定寰椎爆裂性骨折患者的病历资料,男21例,女11例;年龄22～59岁,平均41.8岁.术前均行颈椎张口位及侧位X线片、CT及MR检查.不稳定性寰椎骨折17例,不稳定性寰椎骨折合并枢椎骨折15例,其中6例有不同程度的脊髓损害表现,ASIA分级为D级5例、C级1例.32例患者接受一期后路寰枢椎固定融合术.术后观察脊髓功能恢复情况,均行过屈、过伸位X线片和三维CT检查观察寰枢椎复位、融合及内固定情况,采用寰齿前间距(atlantodens interval,ADI)、寰椎侧块移位程度(lateral mass distance,LMD)及疼痛视觉模拟评分(visual analogue score,VAS)评价疗效并记录并发症.结果 所有患者均获得随访,随访时间10～24个月,平均15.6个月.骨折与寰枢椎骨性融合时间为5～10个月,平均6.9个月.术前颈枕区VAS评分平均为(5.0土1.4)分,末次随访时(1.0土0.7)分,差异有统计学意义.脊髓功能均得到不同程度地改善,术前D级5例中4例恢复至E级、1例无明显改善,术前C级1例恢复至D级.术后X线片和CT均示复位满意,术前ADI平均为(4.6±1.2) mm,末次随访时为(2.4±1.0) mm;术前LMD平均为(5.6±2.2) mm,末次随访时为(1.2±1.0) mm,差异均有统计学意义.结论 一期后路寰枢椎椎弓根固定融合术治疗不稳定寰椎爆裂性骨折临床可行,能避免枕颈融合,但寰椎椎弓根螺钉置钉技术具有挑战性.“,”Objective To assess the clinical results of one stage posterior atlanloaxial pedicle screw fixation and fusion for unstable atlas burst fracture.Methods A retrospective analysis of clinical data including 32 cases,which were admitted according to the inclusion and exclusion criteria between May 2010 and December 2013.There were 11 females and 21 males whose age ranged from 22 to 59 years (mean 41.8 years).X-ray,CT scan reconstruction and MRI were done before operation to evaluate the injury of ligament and fracture.There were 17 cases of unstable atlas burst fracture,including 5 cases Jefferson fracture,8 cases untypical Jefferson fracture,and 4 cases lateral mass fracture combined with anterior arch or posterior arch fracture.There were 15 cases combined with axial fracture,9 cases combined with dens fracture,4 cases with axial body fracture,and 2 cases with Hangman fracture.The patients had various degrees of occipital neck pain,limited mobility and neurological dysfunction.Degree C in 1 case and degree D in 5 cases were assessed by the American Spinal Cord Injury Association (ASIA) impairment scale.All patients were treated with one stage posterior atlantoaxial pedicle screw fixation and fusion.All patients were assessed clinically by neurologic recovery,atlantoaxial reduction and bone graft fusion.The preoperative and postoperative atlanto-dens interval (ADI),lateral mass distance (LMD) and VAS were measured and statistically analyzed.Complications were observed.Clinical outcome of last follow-up was evaluated by dynamic X-ray and CT scan.Results All patients were followed up.The follow-up time ranged from 10 to 24 months (mean 15.6 months).The healing time of bone fusion ranged from 5 to 10 months with an average follow-up time of 6.9 months.The average preoperative VAS score was 5.0± 1.4 while the score of last follow-up was 1.0±0.7,with statistically significant differences.Neurological status improved in all patients but one.Four cases with grade D improved to E,and one cases with grade C improved to D.Postoperative cervical spine X-ray and CT showed that the sagittal cervical spine alignment was restored.The preoperative ADI was 4.6±1.2 mm,which was statistically significant different with last follow-up the ADI of 2.4±1.0 mm.There were statistically significant difference between preoperative LMD of 5.6±2.2 mm and postoperative LMD of 1.2± 1.0 mm.Conclusion The posterior atlantoaxial pedicle screw for unstable atlas burst fracture combined with atlantoaxial instability seems to be effective.It is technically demanding to place screw into the lateral mass of the atlas.