创伤性下颈椎不稳定的治疗策略选择  

The surgical options to treat the traumatic instability of subaxial cervical spine

作　　者：曹鹏[1] 梁裕[1] 龚耀成[1] 郑涛[1] 张兴凯[1] 吴文坚[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院骨科、上海市伤骨科研究所,200025

出　　处：《中华创伤骨科杂志》2007年第10期947-950,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨创伤性下颈椎不稳定的外科治疗方法及其预后。方法1998年1月～2006年5月对77例创伤性下颈椎不稳定患者采用Allen—Fergurson下颈椎损伤分类方法，结合患者的全身情况及伴随损伤状况、神经学状态、致压物部位、有无伴随的创伤性椎间盘突出或损坏、有无伴随的小关节交锁脱位、损伤累及的节段及数目、患者的经济状况和自我要求来决定相应的治疗方案。采用前路、后路或前后联合入路进行下颈椎减压和重建，其中前路手术41例，后路手术28例，前后联合入路手术8例。结果所有患者术后获平均3年8个月（3个月～6年1个月）随访。最常见的损伤类型为屈曲．牵张型和屈曲-压缩型。术前平均JOA和VAS评分分别为10．5分和8．6分，术后分别为15．1分和2．8分。ASIA评分从术前的平均51．5分提高到术后最终随访时的65．2分。不完全性脊髓损伤患者ASIA神经功能评级平均提高1～2级，完全性脊髓损伤者无恢复。术前平均Cobb角、椎体前滑移距离、椎间隙高度分别为后凸23．0°、6．2mm和67％，术后最终随访时分别为前凸2．6°、0．4mm和94％。所有手术节段均完全融合。12例患者发生术后并发症或合并症。结论应根据下颈椎损伤的类型并具体结合患者的全身情况和损伤节段的局部病理解剖及神经学状况来综合考虑最佳的手术策略。Objective To evaluate surgical options to treat the traumatic instability of subaxial cervical spine and their prognosis. Methods The anterior, posterior or combined approaches were chosen to decompress and reconstruct the subaxial cervical spine for 77 cases of the traumatic instability of subaxial cervical spine whose average age was 32 years old （18-65 years）. The surgical options were selected according to their Allen-Fergurson＇s classification, their general health and concomitant traumatic condition, their neurological function, the location of compressor, the presence or absence of concomitant traumatic disc herniation /damage or locked-facet dislocation, the involved vertebral segments, as well as the patient＇ s financial conditions and decision. Results The follow-ups averaged 3 years and 8 months （3 months to 6 years and 1 month）. The distraction-flexion and compression-flexion were the most frequent injury subtypes. After operation, there were improvements in average functional scores and radiological parameters to different extents. Fusion was achieved in all the patients and 12 complications occurred. Conclusion The best surgical strategy should be determined by the type of subaxial cervical injury, the patient＇s general health, the local pathological anatomy and neurological function of injured vertebral segments.

关 键 词：颈椎 创伤和损伤 分类 外科手术 

分 类 号：R686[医药卫生—骨科学]