颈椎屈曲牵张性损伤的前路手术复位与固定  

Anterior reduction and fixation for distractive flexion injuries of the subaxial cervical spine

作　　者：赵剑[1] 刘璠[1] 潘丞中[1] 赵敦炎[1] 施红光[1] 

机构地区：[1]南通医学院附属医院骨科,江苏省南通市226001

出　　处：《中华创伤骨科杂志》2004年第11期1214-1217,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的利用前路手术复位、固定治疗颈椎屈曲牵张性(DF)损伤,总结其临床疗效并探讨其适应证。方法回顾总结29例颈椎DF损伤病例,结合术前影像检查按Allen法评定损伤分期,按ASIA标准评定神经损伤程度。所有病例术前均未做牵引复位,采取早期(伤后72h内)颈前路脱位椎间撑开结合撬拨技术复位,再以自体髂骨植骨、前路带锁钢板内固定治疗。观察手术效果,评估神经功能恢复情况。结果随访6～18个月,效果满意。29例患者中2例DF1期,均无神经损伤;17例DF2期,10例不全性神经损伤,其余均不伴神经损伤;10例DF3期,2例不全性神经损伤,8例完全性神经损伤。术前MRI检查显示6例合并椎间盘损伤(26%),其中DF2期2例,DF3期4例。所有DF2期与8例DF3期患者术中成功复位,2例DF3期改行后路复位。本组无发生手术及内固定相关并发症,3例术后出现神经损伤短期内加重现象。结论颈椎DF损伤时采用前路减压复位技术能安全、有效地恢复解剖序列,结合应用前路钢板,能取得良好疗效,尤其适用于DF1、2期损伤的病例。Objective To determine whether reduction and plate fixation through anterior approach is effective in the treatment of distractive flexion (DF) injuries of the subaxial cervical spine. Methods Records of 29 patients with DF injuries were retrospectively studied. Injury stages (Allen classification) were evaluated based on preoperative radiographic results. Neurological functions were recorded as ASIA Grade. Without preoperative tractive reduction, all the patients were treated at an early stage (within 72 hours after injury) by anterior reduction using intervertebral distraction and lever technique followed by autograft fusion and anterior locking plate fixation. Results 2 patients were classified as DF stage 1 and neurologically intact; 17 patients as DF stage 2 with 10 neurologically incomplete and the others neurologically intact; 10 patients as DF stage 3 with 2 neurologically incomplete and the others neurologically complete. Disc injury was identified in 6 of all the patients by MRI (26%, 2 from DF stage 2 and 4 from DF stage 3). All the patients except 2 DF stage 3 ones were successfully reduced and fixed without operative complications, though 3 suffered from short term neurological function deterioration. All the patients were followed up for 6 to 18 months and the clinical results were satisfactory. Conclusion Anterior reduction is a safe and efficient technique, especially for DF stage 1 and stage 2 cases, and anterior plate can provide sufficient stability in the treatment of DF injuries of the subaxial cervical spine.

关 键 词：颈椎 脱位 复位 骨折固定术 

分 类 号：R687.32[医药卫生—骨科学]