摘要
目的探讨全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁的临床效果。方法回顾性分析2010年3月至2013年3月我院收治的60例下颈椎骨折脱位伴关节突交锁患者的临床资料。其中单侧小关节突交锁23例,双侧小关节突交锁37例。56例合并脊髓损伤,神经功能按美国脊髓损伤学会的分类标准（ASIA）[1]：A型5例,B型21例,C型23例,D型7例。所有患者入院生命体征平稳后立即在全麻下行颅骨牵引,复位后行前路减压Cage融合钛板内固定术或损伤节段椎体次全切钛网植入植骨钛板内固定术。结果本组病例中,53例获得完全复位,成功率88.33%,7例达到90%复位,复位效果尚满意。所有患者完全复位,无大血管、食管意外损伤;5例术后出现轻度吞咽困难、声音嘶哑,予以激素、雾化治疗后逐渐恢复;2例ASIA A级患者于术后15、19 d死于肺部感染、呼吸衰竭。余58例患者均获得18~30个月随访,平均24个月。按ASIA分型,3例A型治疗前后无变化;B型21例,转为C型13例、D型5例;C型23例,转为D型13例,E型8例;D型7例,均转为E型。结论全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁是相对安全、有效的治疗方法。
Objective To investigate the clinical efficiency of skull traction under general anesthesia combined with anterior cervical decompression and fusion fracture dislocation with locked facets. Methods Clinical data of 60 patients suffering from lower cervical spine fracture and dislocation with locked facets admitted in our hospital from March 2010 to March 2013 were collected and retrospectively analyzed. There were 23 cases of unilateral facet interlocking and 37 cases of bilateral facet interlocking. Fifty-six cases were accompanied with spinal cord injury,including 5 cases of A type,21 cases of B type,23 cases of C type,and7 cases of D type based on the nerve function according to American Spinal Injury Association（ ASIA）classification criteria. All patients with stable vital signs were given skull traction immediately after general anesthesia,and underwent reset and anterior decompression and fusion fixation cage or damaged cervical corpectomy followed by titanium mesh implantation with bone titanium plate fixation. Results Fifty-three patients obtained complete reset,with a successful rate of 88. 33%,and the other 7 patients got 90% reset and were satisfied with the outcome. No accidental injuries on large blood vessels and esophagus were observed. Five patients had mild difficulty in swallowing and hoarseness,but gradually recovered after hormones treatment and nebulization therapy. After surgery,ASIA classification showed that 3 cases of type A had no change before and after treatment,13 cases from 21 type B cases turned into type C and 5 cases into type D,13 cases from 23 type C cases turned into type D and 8 into type E,and all 7 type D cases turned into type E. Conclusion Skull traction under general anesthesia combined with anterior cervical decompression and fusion fracture locked facets is relatively safe and effective treatment for cervical fracture dislocation.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2016年第1期93-96,共4页
Journal of Third Military Medical University
关键词
全身麻醉
颅骨牵引
颈前路手术
颈椎
脊柱骨折
脱位
关节突交锁
general anesthesia
skull traction
anterior cervical surgery
cervical vertebra
spinal fracture and dislocation
locked facet
