摘要
目的探讨延期外科治疗严重下颈椎骨折脱位的临床疗效。方法对1998—2006年行延期外科治疗的84例严重下颈椎骨折脱位患者的临床资料进行回顾性分析。所有患者手术时间均为伤后5d以上，手术方式包括前路减压复位内固定与前后路联合减压复位内固定。通过Frankel评分、视觉量化疼痛评分（VAS）对术后神经功能及临床疗效进行评价，所有患者平均随访4．5年（1～6年）。结果术后54例患者获得完全复位，30例复位达到80％以上，随访期间全部患者均获得了满意的融合。合并脊髓损伤74例，其中63例不全脊髓损伤患者（85％），术后神经功能均有不同程度的改善，无一例神经功能障碍加重，Frankel评分术后较术前平均提高0．5分，末次随访VAS评分0—7分，平均2．5分。随访期间无严重内固定并发症如钢板、螺钉断裂发生，仅2例患者在术后1年后观察到前路钢板远端翘起，因无相关症状，予继续观察中。结论严重下颈椎骨折脱位选择延期外科治疗相对安全，正确的手术策略对于有效复位、解除神经压迫、避免进一步神经损害有着重要意义。
Objective To evaluate the efficiency of late surgical treatment for severe lower cervical fracture and dislocation. Methods A retrospective analysis was conducted on 84 cases of severe lower cervical fracture and dislocation treated in our department from 1998 to 2006. All the cases received surgery over 5 days after injury. The surgical treatment included decompression, reduction and internal fixation through anterior and anteroposterior approaches. Postoperative neurologic function and therapeutic effects were evaluated by Frankel grade scores and visual analogue scale （VAS） in the follow-up for 1-6 years （ average 4.5 years）. Results Of all, 54 cases obtained complete reduction and 30 obtained over 80 percent reduction. Solid fusion was obtained in all cases at the follow-up. Concomitant spinal cord injury was found in 74 cases, of whom 63 （85%） with incomplete neurological deficits experienced improvement after operation but none of them showed aggravated neurological dysfunction. Frankel scores were increased by 0.5 point compared to the preoperative values and VAS scored 0-7 points （ average 2.5 points） at final follow-up. No major complications associated with internal fixation such as plates and screws slipping, loosening or breaking occurred. The distal side of plates protruded anteriorly were observed in only 2 cases one year after surgery, which was still under observation because of no associated symptoms. Conclusion The results of this study demonstrate that late surgical treatment for severe fracture and dislocation of lower cervical spine is comparatively safe. A correct surgery strategy plays a vital role in satisfactory reduction, relief of neurological compression and prevention of further neurological injury.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2007年第9期662-665,共4页
Chinese Journal of Trauma
关键词
脊髓损伤
颈椎骨折
外科手术
Spinal cord injuries
Cervical spine fractures
Sugical procedures, operative
