屈曲牵张性下颈椎损伤治疗策略  

Treatment strategies for lower cervical distractive flexion injuries

作　　者：徐荣明[1] 马维虎[1] 赵刘军[1] 刘观焱[1] 孙韶华[1] 阮永平[1] 胡勇[1] 蒋伟宇[1] 顾勇杰[1] 

机构地区：[1]宁波市第六人民医院骨科,315040

出　　处：《中华创伤杂志》2008年第8期615-618,共4页Chinese Journal of Trauma

摘　　要：目的总结分析屈曲牵张性下颈椎损伤治疗策略。方法选择2002年1月-2007年6月共68例屈曲牵张性下颈椎损伤患者，其中男43例，女25例；年龄18～72岁，平均43岁。按照Allen分型：Ⅰ度7例，Ⅱ度19例，Ⅲ度29例，Ⅳ度13例。所有患者入院后均行轻度屈曲位颅骨牵引制动（3～4kg）。单纯后路手术26例，采用椎弓根螺钉、侧块螺钉或经关节螺钉固定，Ⅰ期前后联合手术42例。术后随访其疗效。结果随访6～65个月，平均34个月。2例后路切口感染，经过清创换药等治疗愈合，2例术后短期内神经症状加重，通过甲基强的松龙等治疗后恢复。神经功能除A级18例没有恢复外，均有1级以上改善。其中有11例B级患者术后有4例达C级，有5例达D级；C级10例中有6例恢复至D级，4例达E级，D级15例全部达E级。未见内置物松动、脱落及断裂者，植骨在3～4个月内融合，未发现不融合者。未出现与手术固定技术直接相关的并发症。结论屈曲牵张性下颈椎损伤治疗需根据Allen分型决定治疗策略。对于Ⅰ度和Ⅱ度损伤采用后路手术；而对于Ⅲ度和Ⅳ度损伤，只要全身情况允许可采用Ⅰ期前后联合手术治疗。Objective To discuss the strategies for treatment of lower cervical distractive flexion injuries. Methods Sixty-eight patients including 43 males and 25 females at age range of 18-72 years （average 43 years ） suffered from lower cervical distractive flexion injuries were operated from January 2002 to June 2007. According to Allen＇ s classification, there were 7 patients at grade Ⅰ , 19 at grade Ⅱ , 29 at grade m and 13 at grade Ⅳ. Temporary skull traction was used for each subject before surgery. Only posterior approach was performed in 26 patients who were fixated by pedicle screw system, lateral mass screw system or transarticular screw system. Combined anterior and posterior approach was applied for the other 42 patients at one stage. The curative effect was followed up for all patients after the proce- dures. Results All patients were followed up for 6-65 months （average 34 months） , which showed posterior incision infection in 2 patients who were cured after debridement or change dressing. Two patients with aggravated neural symptome were cured following treatment with methylprednisolone. Neural function was improved at least for one level in all patients except for 18 patients （Frankel A）. Of 11 patients at grade B, there were 4 patients improved to grade C and 5 to grade D. Of 10 patients at grade C, there were 6 patients recovered to grade D and 4 to grade E. All 15 patients at grade D reached grade E. It was not found loosening, breakage or defuxion. The graft bone was fused within 3-4 months, with no any complications related to surgical fixation. Conclusions The strategies for lower cervical distractive flexion injuries should be taken according to Allen＇s classification. Single posterior procedure is suitable for grade Ⅰ and Ⅱ injuries. While combined posterior and anterior procedure can be used for grade m and IV injuries.

关 键 词：颈椎 骨折固定术 临床分析 治疗方法 

分 类 号：R686[医药卫生—骨科学]