摘要
[目的]探讨并评估在下颈椎骨折脱位伴关节突交锁时安全、简便和有效的治疗策略。[方法]对16例创伤性下颈椎骨折脱位伴关节突交锁的患者于清醒状态及X线透视机监视下先行早期持续闭合颅骨牵引复位。所有患者在治疗前均行X线片和MRI／CT检查及ASIA神经功能评级。持续闭合牵引复位时行动态ASIA神经功能评级及X线透视机监视。损伤至开始牵引复位的间隔平均为31h（6～52h）。复位成功后维持颅骨牵引并择期行颈前路或颈前后路联合手术。9例患者于复位成功后再次行MRI扫描。[结果]治疗前MRI显示分别有8例和5例患者存在脱位节段的椎间盘突出和损坏；ASIA神经功能评级分别为：C级7例，D级5例，E级4例。16例患者均闭合复位成功且无一例出现神经功能恶化。复位成功后再次MRI扫描显示：6例脱位节段的椎间盘突出中有2例接近自动回纳，4例仍维持原样；3例脱位节段的椎间盘损坏中有2例维持原样，另l例转变为椎间盘突出。平均牵引重量为19kg（10～32kg），平均牵引时间为53min（30～135min）。[结论]当患者处于清醒及检体合作的状态下通过动态神经功能评级及X线透视机监视，对下颈椎骨折脱位伴关节突交锁行早期持续闭合颅骨牵引复位，择期根据全身及局部状况行颈前路或颈前后路联合手术是一种安全、简便和有效的治疗策略。
[ Objective] To evaluate a simple, safty and effective therapeutic option to treate subaxial cervical fracture-dislocation with locked-facet . [ Method] With the patients being awake and supervized under X-ray fluoroscopy, the authors used the early and continued closed skull traction-reduction to treate 16 cases of traumatic subaxial cervical fracture-dislocation with locked-facet. Before the beginning of the treatment, all the patients were taken for X-ray plain films and MRI/CT examinations as well as American Spinal Injury Association（ASIA） neurological function grade. The dynamic ASIA neurological function scale and X-ray fluoroscopy examnations were asked during the skull traction - reduction procedures. The average interval from the traumatic events to begin to skull traction - reduction was 31 hours（6-52 hours）. The authors would continue the skull traction to maintain the anatomy position as soon as they succeeded in reducing the dislocation with locked-facet, forthmore they would take the anterior operation or combinations with anterior and posterior operations during the best condition. [ Result] The MRI scans showed that there were 8 disc hernations and 5 disc disruptions at the dislocation levels before traction - reduction procedures. The ASIA scale were 7 grade C, 5 grade D and 4 grade E, respectively. All the 16 cases succeeded in reduction as well as no neurological deterioration occurred. The postreduction MRI scans showed that 2 disc herations had converted to nearly normal disc position and another 4 disc hernations remained unchanged. Accordingly, 2 disc disruption remained unchanged and another case had converted to disc hernation. The average traction weight was 19 kg（ 10 - 32 kg） and average traction time was 53 minutes（30 - 135 minutes）. [ Conclusion ] Under the intensive dynamic ASIA neurological function grade and X-Ray fluoroscopy examnations, with the patients being awake and co-operation, the early and continued closed skull traction-reduction and then performing elective anterior or anterior-posterior surgery depending on the patientg overall and local status to treate subaxial cervical fracture-dislocation with locked-facet is safe and effective.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2007年第2期81-84,共4页
Orthopedic Journal of China
关键词
下颈椎骨折脱位
关节突交锁
早期持续闭合牵引复位
治疗策略
subaxial cervical fracture-dislocation
locked-facet
early and continued closed traction-reduction
therapeutic options
