摘要
[目的]总结前后路联合减压复位内固定治疗难复性下颈椎外伤性滑脱伴关节突交锁的临床经验和疗效。[方法]2005年10月～2009年2月收治34例难复性下颈椎外伤性滑脱伴关节突交锁患者，其中男25例，女9例；年龄21～61岁。经三维CT检查证实：双侧关节突交锁21例，单侧关节突交锁13例。手术方式均为前后路联合减压复位内固定，其中13例Ⅰ期行前路减压、后路解锁融合固定、前路融合固定手术，21例Ⅰ期行后路解锁融合固定、前路减压融合固定手术。将Frankel分级作为脊髓恢复情况的疗效评价标准。[结果]术后随访7～35个月，平均16个月。术中所有螺钉（包括侧块螺钉和椎弓根螺钉）均成功置入。术后关节突交锁及脱位均得到解除和复位。无围手术期死亡、切口感染、内固定松动断裂及术后神经功能损伤加重等发生。随访期问所有患者均获得良好骨性融合。不完全性脊髓损伤患者均有不同程度的恢复。Frankel分级恢复一级者23例，恢复二级者8例，无变化者3例。[结论]前后路联合减压复位内固定是治疗难复性下颈椎外伤性滑脱伴关节突交锁的理想术式，具有操作相对安全和固定牢固等优点。只要正确掌握颈椎侧块和椎弓根的解剖学特点和毗邻结构，术中仔细操作，可避免大多数并发症的发生。
[ Objective ] To introduce the clinical experiences and efficiency in surgical treatment of irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet dislocation with decompression, reduction and internal fixation through anteroposterior approaches. [ Methods] A total of 34 cases of irreducible traumatic spondylolisthesis of lower cervical ver- tebrae combined with facet dislocation （25 males and 9 females, with age range of 21 -61 years）treated from October 2005 to February 2009 were analyzed. Twenty-one cases showed double joints interlocking and 13 cases single facet joint interlocking, which was indentified by the three dimensional CT scan. All cases were treated with decompression, reduction and internal fixation through anteroposterior approach. Among them, 13 cases were done through one stage anterior delompression, posterior unlock ,fusion and stabilization as well as anterior fusion and stabilization in turn ,21 cases were done through one stage posterior unlock ,fusion and stabilization as well as anterior decompression, fusion and stabilization in turn. The Frankel grade scores was used as the judging criteria for the recovery of the spinal cord. [ Results] All patients were followed up from 7 to 35 months, and the mean follow-up time was 16 months. Lateral mass screw and pedicle screw insertion were successful in all cases. After operation, the joint interlocking and dislocation were all released and reduced. There were no death, infection, intcrfixation failure or neurological function deterioration. Solid fusion were obtained in all cases in the follow-up. Incomplete spinal cord lesions had some recovery of nervous function postoperatively. Besides,one grade was improved in 23 cases by Frankel grade scores and 2 grades in 8 case. There were no improvements in 3 cases. [ Conclusion ] Decompression, reduction and internal fixation through anteroposterior approaches is an appropriate treatment method for the irreducible traumatic snondvlolisthesis of lower cervical vertebrae combined with facet disclocation, with the advantages of relatively safe operation and strong stability. Most complications can be prevented under correct control of anatomic features and adjacent structures of the cervical lateral mass and pedicle as well as careful operation.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第8期641-644,共4页
Orthopedic Journal of China
关键词
颈椎
滑脱
关节突交锁
前后路联合手术
cervical spine, spondylolisthesis, locked-facet, posterior-anterior operation
