难以复位合并小关节绞锁的下颈椎脱位的手术治疗  

Surgical treatment of the irreducible dislocation of the lower cervical spine with associated tiny joint interlocking

作　　者：屠冠军[1] 常楚[1] 金明熙[1] 朱悦[1] 吕刚[1] 

机构地区：[1]中国医科大学附属第一医院骨科,沈阳110001

出　　处：《中华创伤杂志》2005年第6期432-435,共4页Chinese Journal of Trauma

摘　　要：目的探讨难以复位合并小关节绞锁的下颈椎脱位的手术治疗。方法12例下颈椎脱位患者,经三维CT检查证实8例有单侧小关节绞锁,4例双侧小关节绞锁;MRI检查发现,12例患者均有椎间盘损伤,其中4例为椎间盘破裂,8例为椎间盘突出;经颅骨牵引后未能复位的12例患者,Ⅰ期行前路减压、后路解锁融合固定、前路融合固定手术。结果12例患者术后原有神经症状未加重,小关节绞锁及脱位均得到解除和复位;术后1～2周内大部分(10/12)患者神经功能按改良Frankel分级上升:1例A级→B级(2例A级无变化),B级→C级2例,C级→D级3例,C级→E级3例,D级→E级1例。住院时间9～19d,平均14d。结论前路减压、后路解锁融合固定、前路融合固定术是治疗难以复位合并小关节绞锁的下颈椎脱位的理想方法。Objective To investigate the surgical treatment of the irreducible dislocation of the lower cervical spine associated with tiny joint interlocking. Methods Of 12 cases suffering from the dislocation of the lower cervical spine, eight showed single joint interlocking and four double joint interlocking, which was identified by the three dimensional CT scan. The MRI examination showed that all cases had intervertebral disk injury including intervertebral disk rupture (four cases) and intervertebral disk herniation (eight cases). All the cases received the skeletal skull traction, one stage anterior depression, posterior unlock, fusion and stabilization as well as anterior fusion and stabilization in turn. Results After operation, the nervous symptoms of all cases were not aggravated, and joint interlocking and dislocation were all released and reduced. Within 1-2 weeks after operation, the nervous function of most patients (10/12) was upgraded based on the improved Frankel Grade: there was one case from Grade A to Grade B (2 cases remained at Grade A), two from Grade B to Grade C, three cases from Grade C to Grade D, three cases from Grade C to Grade E and one case from Grade D to Grade E. Hospitalization was 9-19 days (average 14 days). Conclusion Anterior depression, posterior unlock, fusion and stabilization as well as anterior fusion and stabilization in turn is an appropriate treatment method for the dislocation of the lower cervical spine with tiny joint interlocking and intervertebral disk injury.

关 键 词：小关节绞锁 下颈椎脱位 手术治疗 复位 FRANKEL 三维CT检查 前路减压 前路融合 MRI检查 椎间盘损伤 椎间盘破裂 椎间盘突出 骨牵引后 固定手术 神经症状 神经功能 住院时间 患者 固定术 后路 术后 A级 

分 类 号：R687.3[医药卫生—骨科学]