下颈椎骨折脱位的手术治疗  

Treatment of lower cervical fracture and dislocation with internal fixation

作　　者：谢肇[1] 吴雪晖[1] 张劲松[1] 许建中[1] 周强[1] 马树支[1] 

机构地区：[1]第三军医大学西南医院骨科,重庆400038

出　　处：《中华神经医学杂志》2007年第4期392-394,共3页Chinese Journal of Neuromedicine

基　　金：国家高技术研究发展计划资助重大攻关课题(863计划)(2003AA205020)

摘　　要：目的观察下颈椎骨折脱位伴脊髓损伤减压内固定手术治疗的效果。方法采用闭合复位结合前路或一期前、后路手术治疗急性下颈椎骨折脱位伴脊髓损伤患者46例。术后随访6～32个月,定期摄片观察植骨融合和颈椎稳定性。以Frankel分级作为脊髓恢复情况的判断标准。结果术后检查证实植骨均在4～6个月内融合,颈椎稳定性好,无内固定松动、脱出,脊髓功能有不同程度的恢复。结论术前牵引复位,可以使大部分骨折脱位复位,安全有效。有选择地采用一期前后路或单纯前路内固定手术可使受伤节段达到术后即刻稳定,方便术后护理和功能锻炼,有利于脊髓功能的恢复。Objective To investigate the effects of decompression and internal fixation for the treatment of the severe fracture and dislocation of the lower cervical spine. Methods Totally 46 cases （30 males, 16 females, aged from 17 to 67 years, mean age 46 years） of the fresh severe fracture and dislocation of the lower cervical spine underwent primary decompression and bone graft fusion and internal fixation through anterior and posterior approaches after traction and closed reduction. The hospitalization duration was 3-12 d, and the follow-up period ranged from 6 to 32 months with average 17 months. The X-ray film was taken periodically for observation of the fusion of the bone grafts and the cervical stability. The Frankel grading was used as the judging criteria for the recovery of the spinal cord function. Results Fusion was found in all 46 cases between 4 and 6 months after the operation with the good cervical stability. No failure of the internal instruments or late cervical re-dislocation was found. Conclusion The safe and satisfactory result can be achieved in the majority of the patients with severe lower cervical fracture and dislocation through preoperative traction and closed reduction. The primary internal fixation through anterior and posterior approaches can offer immediate stability to the injured segments. The technique is of benefit to the patients for the functional recover of the spinal cord.

关 键 词：下颈椎 骨折脱位 内固定 

分 类 号：R687.3[医药卫生—骨科学]