严重创伤性颈椎后凸畸形的治疗策略  

Surgical treatment strategy for severe traumatic cervical kyphosis

作　　者：周许辉[1] 方加虎[1] 袁文[1] 贾连顺[1] 刘洋[1] 迟志永[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中华创伤杂志》2007年第9期650-653,共4页Chinese Journal of Trauma

摘　　要：目的探讨严重创伤性颈椎后凸畸形的外科治疗策略。方法回顾性分析严重创伤性颈椎后凸畸形9例，术前后凸Cobb角50°～71°，平均59°。先以在伸展侧位片测量椎体后缘切线夹角作为依据，决定后部截骨高度及角度，行颈椎后路截骨及前路松解术。术后行颅骨牵引使松解后颈椎后凸达到最大可能的矫正，7—10d后Ⅱ期行颈前路植骨融合内固定术。结果本组患者随访14—32个月（平均28个月），术中、术后无脊髓损伤加重，颈部疼痛症状消失，脊髓损伤神经功能有所恢复，植骨部位均获得骨性愈合。后凸Cobb角-10°～11°，平均-5°，纠正率为85％。结论通过动态颈椎后缘切线夹角测量可决定合适的后路截骨高度、椎间撑开高度及植骨块的大小。分期手术及手术间期持续牵引能够充分矫正严重创伤性颈椎后凸畸形。Objective To analyze the outcome of surgical treatment for severe traumatic cervical kyphosis. Methods A retrospective study was performed on 9 patients with severe cervical kyphosis after trauma. Preoperative Cobb angle of kypbosis ranged from 50° to 71° （mean 59°）. The anterior release and posterior osteotomy were performed firstly after the osteotomy height and angles of lamina and facet were decided according to the angles between the posterior vertebral body tangents at every involved level on lateral cervical radiograph in extension. Then, skull traction was maintained until the final anterior correction, fusion and internal fixation were under satisfactory condition after 7-10 days. Results All patients were followed up for 14-32 months （ mean 28 months）. There was no major complication such as neurological injury occurred intra-operatively or post-operatively. Neck pain disappears and neural functions recovered partly postoperatively. The Cobb angle of kyhpesis ranged from -10° to 11° （mean -5° ）, with correction rate of 85 %. Conclusions The angle between the posterior vertebral body tangents at every involved level is a reliable criterion for deciding height of dorsal osteotomy, the segregate heights between vertebral body and bone graft length. Severe traumatic cervical kyphosis can be fully corrected through staged operation and continual skull traction.

关 键 词：颈椎 后凸畸形 骨折 脊柱融合术 

分 类 号：R686[医药卫生—骨科学]