颈椎侧块钛板螺钉内固定治疗颈椎骨折脱位  

TREATMENT OF LOWER CERVICAL FRACTURE DISLOCATION BY TITANIUM SCREW-PLATE INTERNAL FIXATION ON CERVICAL LATERAL MASS

作　　者：张新[1] 何慕舜[1] 张展奎[1] 李铁峰[1] 叶俊强[1] 陈伟全[1] 左文建[1] 欧阳冰[1] 曾月东[1] 

机构地区：[1]深圳市龙岗中心医院(深圳市第九人民医院)骨科,广东518116

出　　处：《中国修复重建外科杂志》2007年第4期374-377,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨颈椎侧块钛板螺钉内固定治疗颈椎骨折脱位的手术疗效。方法2001年9月-2006年3月,收治颈椎骨折脱位31例,男24例,女7例;年龄20-63岁。车祸伤25例,高处坠落伤4例,重物砸伤2例。颈椎损伤节段C31例,C45例,C512例,C610例,C73例;病程1-23d。其中29例合并脊髓神经根损伤,Frankle分级,A级14例,B级3例,C级7例,D级3例,E级2例（合并神经根损伤伴有手、肩麻木）,均行脊髓减压、小关节植骨融合、侧块钛板内固定术;另2例无脊髓神经根损伤,仅行小关节植骨和内固定。术后摄X线片观察植骨融合、颈椎活动及内固定稳定情况,并按Frankle分级法评定神经功能恢复情况。结果术后31例均获6个月-4年随访。X线片可见颈椎小关节植骨融合,时间为3-6个月。术后6个月X线片显示内固定牢固稳定,无折断松动等并发症。29例脊髓神经根损伤者中,按Frankel分级,术前A级14例中,术后13例为B级,1例为C级;术前B级3例中,术后为C级2例,D级1例;术前C级7例中,术后D级3例,E级4例;术前D级3例中,术后均为E级;2例E级术后无变化,合并神经根损伤,术后短期内手、肩麻木消失。结论颈椎侧块钛板螺钉为后路短节段固定,最大限度地保留了颈椎的活动度,钛板螺钉固定在颈椎后部的关节柱上,对过伸过屈损伤有良好的稳定作用,是治疗颈椎骨折脱位一种积极有效的方法。Objective To evaluate surgical results of the titanium screw-plate internal fixation in treatment of the lower cervical fracture dislocation. Methods From September 2001 to March 2006, 31 patients （24 males, 7 females; age range, 20-63 years） with the lower cervical fracture dislocation were treated in our department. The injuries were caused by a road accident in 25 patients, a high crash in 4, and a heavy object crash in 2. The fracture dislocation occurred in the following cervical segments：C3 （ 1 patient ）, C4 （5 patients ）, C5 （ 12 patients）, C6 （ 10 patients ）, and C7（3 patients）. The disease course ranged from 1 to 23 days. The associated spinal nerve root injury occurred in 29 patients. The Frankle scaling revealed that 14 patients were at Grade A, 3 at Grade B, 7 at Grade C, 3 at Grade D, and 2 at Grade E （associated nerve root injury with hand and shoulder numbness）. The 29 patients underwent the spinal cord decompression, the grafting fusion of the small joints, and the lateral mass titanium screw-plate internal fixation ; 2 patients without nerve injury underwent only the grafting fusion of the small joints and the lateral mass titanium screwplate internal fixation. The bone fusion, cervical vertebra movement, and internal fixation condition were observed by the X-ray examinations postoperatively. The nerve function recovery was evaluated by the Frankle scaling system. Results The followed-up in all the patients for 6 months to 4 years revealed that the small joint fusion time was 3-6 months, with an average of 3.6 months. The cervical X-ray films showed that there was no instability or fracture looseness of the internal fixation at 6 months. Among the 29 patients with the spinal nerve root injury, 14 were at Grade A preoperatively but 13 were improved at Grade B and 1 at Grade C postoperatively; 3 were at Grade B preoperatively but 2 were improved at Grade C and 1 at Grade D postoperatively; 7 were at Grade C preoperatively but 3 were improved at Grade D and 4 at Grade E

关 键 词：颈椎 骨折 脱位 后路手术 

分 类 号：R687.3[医药卫生—骨科学]