摘要
目的 探讨下颈椎骨折脱位的手术方式选择及疗效分析.方法 回顾性分析2005年9月—2011年12月收治的50例下颈椎骨折脱位患者的临床资料,其中男37例,女13例;年龄20～80岁,平均41岁.44例采用前路手术复位固定融合,其中4例强直性脊柱炎和2例颈椎极不稳定患者,行前路固定融合＋后路固定融合.2例强直性脊柱炎因极度屈颈体位限制,无法行前路手术而采取后路减压复位固定融合术.2例陈旧性骨折先行后路松解再行前路复位固定融合术.2例二次手术先行后路松解再行前路复位固定融合,再行后路固定融合术.采用美国脊髓损伤协会（ASIA）分级标准评价脊髓损伤情况.结果 50例均获随访12 ～48个月,平均28个月.1例强直性脊柱炎仅行前路复位固定融合手术,术后2个月出现内固定松动,再次脱位.其余49例骨折脱位均获得良好复位,颈椎序列维持良好,均于术后6个月获得骨性融合.完全脊髓损伤患者神经功能均无恢复,不完全脊髓损伤患者ASIA分级均提高1～2级.结论 前路手术治疗下颈椎骨折脱位能达到良好的复位效果,改善脊髓功能.前路手术复位困难或骨折脱位极不稳定且骨质疏松者,应采用后路手术或前后路联合入路手术.
Objective To discuss the selections of surgical treatment for lower cervical spine fracture and dislocation and the treatment outcome.Methods Clinical data of 50 cases of lower cervical spine fracture and dislocation were analyzed retrospectively.There were 37 males and 13 females at mean age of 41 years （range,20-80 years）.Forty-four cases underwent anterior fusion,but 4 with ankylosing spondylitis and 2 with extremely unstable cervical spine were treated with combined posterior fusion.Two cases sustaining ankylosing spondylitis and being unable to be operated via the anterior approach due to the maximum neck flexion limits were treated with posterior decompression and fusion.Two cases developed delayed fracture and underwent posterior release prior to the anterior fixation and fusion.Two cases underwent a second surgery with the posterior release,anterior fusion and posterior fusion performed successively.Neurological performance was evaluated using the American Spinal Injury Association （ASIA）scale.Results All the patients were followed up for mean 28 months （range,12-48 months）.Implant loosening and redislocation occurred in one ankylosing spondylitis case 2 months after anterior fusion.Other 49 cases achieved bony fusion in 6 months.Neurological function showed no recovery in complete spinal cord injury cases,but improved for average ASIA 1-2 grades for incomplete spinal cord injury cases.Conclusions Anterior surgery provides good reduction and neurological improvement in treatment of lower cervical spine fracture and dislocation.For extremely unstable cases or difficult anterior reduction cases,posterior surgery or combined anterior/posterior surgery should be considered.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2015年第3期232-235,共4页
Chinese Journal of Trauma
关键词
脊柱骨折
颈椎
脱位
Spinal fractures
Cervical vertebrae
Dislocations
