摘要
目的探讨不同入路手术治疗下颈椎骨折脱位的效果。方法选择2002年12月-2012年1月收治的下颈椎骨折脱位患者26例，其中男19例，女7例；年龄27—62岁，平均39岁。骨折AO分型：B3．1型12例，B3．2型3例，c2．1型2例，C3．1型3例，C3．2型6例。术前脊髓功能Frankel分级：A级6例，B级5例，C级7例，D级6例，E级2例。术前常规颅骨牵引，根据骨折脱位类型和脊髓损伤情况分别选择前方入路、后方入路和前后联合入路行椎管减压植骨融合内固定术。术后定期复查X线片了解骨折脱位矫正、椎体高度恢复和椎间植骨融合，以及术后脊髓功能恢复情况。结果术中无大血管损伤或脊髓损伤加重等并发症，术后无切121感染、脑脊液漏、植骨块脱出或内固定断裂塌陷等并发症。术后随访12—24个月，平均16个月。本组26例下颈椎骨折脱位均得到矫正，恢复了正常颈椎序列、生理曲度和椎体高度。术后3～6个月椎间植骨均获得骨性愈合，平均融合时间3．5个月。末次随访时Frankel分级：A级6例，B级3例，C级5例，D级5例，E级7例，脊髓功能均有不同程度改善。结论应根据下颈椎骨折脱位不同伤情采取合理的手术方式。前路手术可以直接处理椎体或椎间盘损伤并即刻消除颈椎不稳；后路手术可以直接解除关节突脱位交锁，但需排除颈椎间盘损伤以避免复位时加重脊髓损伤；前后联合入路可以同时处理颈椎骨折脱位和椎间盘损伤，但手术创伤和风险较大。
Objective To investigate outcomes of different surgical approaches for treating cases of fracture and dislocation of the lower cervical spine. Methods The study involved 26 cases of fracture and dislocation of the lower cervical spine treated surgically from December 2002 to January 2012, including 19 males and 7 females with age ranging from 27 to 62 years （average 39 years）. According to the AO classification, there were 12 cases of type B3.1, three of type B3.2, two of type C2.1, three of type C3.1, and six of type C3.2. Preoperative spinal cord function graded by Frankel criteria was six cases of grade A, five of grade B, seven of grade C, six of grade D, and two of grade E. Conventional skull traction was done for all patients before operation. Vertebral cannal decompression and interbody fusion through anterior, posterior or anterior-posterior approaches were determined according to type of fracture dislocation and severity of spinal cord injury. Radiography was performed regularly after operation to review the correction of dislocation, restoration of vertebral height, and interbody fusion. Spinal cord function was also evaluated postoperatively. Results No large blood vessel injury or aggravation of spinal cord injury occurred intraoperatively. There were no complications of incision infection, leakage of cerebrospinal fluid, herniation of bone graft or implant breakage postoperatively. All cases obtained successful correction of fracture and dislocation of the lower cervical spine as well as the recovery of cervical sequence, physiological curvature, and vertebral height in the 12 to 24 months of follow-up （average 16 months）. Bony fusion was obtained for all cases at postoperative 3-6 months （ average 3.5 months）. Spinal function evaluated by Frankel criteria at the latest follow-up showed was grade A in six cases, grade B in three, grade C in five, grade D in five and grade E in seven,with different degree of improvement for all cases. Conclusions Operative approaches should be selected according to the specific status of fracture and dislocation of the lower cervical spine. Anterior approach can be performed for vertebral or intervertebral disc injury straightly and the procedure handles cervical instability immediately. Posterior surgical approach can be used to settle dislocation and interlocking of the articular process directly, but the intervertebral disc injury should be ruled out simultaneously in order to avoid further injury of spinal cord during the reduction process. Combined anterior and posterior surgical approach can be applied to treat fracture and dislocation of lower cervical spine and intervertebral disc injury concurrently but has high risk and large operation wound.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2013年第4期302-306,共5页
Chinese Journal of Trauma
关键词
脊柱骨折
颈椎
脱位
外科手术
Spinal fractures
Cervical vertebrae
Dislocations
Surgical procedures,operative
