摘要
目的探讨下颈椎骨折脱位手术入路的选择和手术疗效。方法回顾性分析我院近年收治的68例下颈椎骨折脱位患者临床资料。患者入院前后均行CT、MRI及X线片检查。行前路手术54例，后路手术10例，前后联合入路手术4例。观察手术前后神经功能恢复、脱位纠正、椎体高度恢复、植骨融合等情况，评估手术疗效。结果所有患者均获随访，时间6～36个月，平均21个月。所有患者术后神经功能障碍无加重。除5例美国脊髓损伤协会（ASIA）分级A级患者神经功能无任何恢复，其余患者ASIA分级均有l～2级提高。所有患者脱位均复位、椎体高度恢复。椎间植骨均融合，平均融合时间为12周。术后复查x线片示内固定位置可，螺钉无松动、脱落，无植骨块松动、脱出。结论对于下颈椎骨折脱位，应根据骨折脱位类型与脊髓受压部位和程度采用不同的手术入路治疗。前路手术较单纯后路或前后路联合手术具备更宽的适应证，手术时间短、出血少，能有效行神经减压，恢复颈椎生理曲度，术后颈椎可获得即刻稳定，利于患者早日康复锻炼，应为下颈椎骨折脱位治疗的首选方法。
Objective To investigate surgical and dislocation of the lower cervical spine. Methods approaches and their effects in treating fracture A retrospective study was performed on data of 68 patients with fracture and dislocation of the lower cervical spine admitted to our hospital in recent years. All patients received CT, MRI and X-ray examination before and after admission. Among them, 54 patients were treated with anterior surgical approach, 10 with posterior surgical approach and four with combined anterior and posterior surgical approach. Neurologic function recovery, dislocation correction, vertebral height restoration and fusion of bone graft were detected postoperatively so as to evaluate surgical outcome. Results None of the patients had aggravation of the neurologic function in follow-up for 6-36 months （average 21 months）. All the patients had 1-2 level improvement according to American Spinal Injury Association （ASIA） classification, except for five patients with ASIA grade A injury. Restorations of dislocation and vertebral height were obtained in all patients. Interbody fusion was achieved in average 12 weeks. Postoperative X-ray films showed satisfactory fixation without loosening or fall of screws, and loosening or protrusion of bone grafts. Conclusions Determination of surgical approaches should be based on the fracture types and dislocation of the lower cervical spine, as well as sites and degree of spinal cord compression. In comparison with posterior surgical approach or combined anterior and posterior surgical approach, the anterior surgical approach has advantages of wider indications, shorter operation time and less bleeding, and can more effectively facilitate neural decompression, cervical physiological curvature recovery, cervical spine stabilization and early rehabilitation exercise. Therefore, anterior surgical approach should be the optimal choice in treatment of fracture and dislocation of the lower cervical spine.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2013年第4期311-315,共5页
Chinese Journal of Trauma
关键词
脊柱骨折
颈椎
骨折固定术
手术入路
Spinal fractures
Cervical vertebrae
Fracture fixation
Surgical approach
