下颈椎骨折脱位合并脊髓损伤的手术治疗  

The surgical treatment of fracture and dislocation of lower cervical spine combined with spinal cord injury

作　　者：巫洪波[1] 姚仕奋[1] 谢惠缄[1] 陈民[1] 江铃波[1] 王大城[1] 

机构地区：[1]广东省惠州市中心医院骨科,516001

出　　处：《河北医药》2009年第14期1722-1724,共3页Hebei Medical Journal

摘　　要：目的探讨下颈椎骨折脱位合并脊髓损伤的手术治疗。方法回顾性分析27例下颈椎骨折脱位合并脊髓损伤患者行手术治疗的临床资料,其中颈椎压缩型骨折脱位15例,颈椎爆裂性骨折脱位4例,单侧小关节脱位5例,双侧小关节脱位3例;美国脊髓损伤学会(ASIA)评分:A级5例,B级7例,C级12例,D级3例。采用前路手术13例,后路手术8例,前后联合入路手术6例。结果术中均无大血管、气管、食管、脊髓意外损伤。术后随访12～36个月,平均18个月。未发生钢板、螺钉松动、断裂等并发症。植骨于术后12周均获得骨性融合,无假关节、骨不连发生。术后颈椎间高度、生理曲度无丢失。完全性脊髓损伤患者术后神经功能均无恢复,但上肢疼痛、麻木有不同程度的缓解。不完全性脊髓患者术后神经功能均有一定恢复,平均ASIA评分提高1～2级。结论根据颈椎损伤的类型采用适合的手术入路手术治疗下颈椎骨折脱位均能达到良好的解剖复位,取得良好的临床疗效。Objective To observe the therapeutic effect of surgery on fracture and dislocation of lower cervical spine combined with spinal cord injury. Methods The clinical data of 27 patients with lower cervical spine fracture and dislocation were retrospectively analyzed. There were 15 cases with vertebral body compressive fracture and dislocation,4 cases with vertebral body bursting fracture and dislocation,5 cases with unilatetal facet dislocation,3 cases with bilateral facet dislocation. All the cases were complicated by spinal cord injury. According to American Spinal Injury Association（ASIA） grades ,5 cases were at grade A,7 cases grade B, 12 cases grade C and 3 cases grade D. All the patients had surgical reduction, decompression, stabilization and fusion. Among these cases,anterior procedure was performed in 13 cases,posterior procedure in 8 cases, combined anterior and posterior procedure in 6 cases. Results All the patients were followed up between 12 and 36 months （mean 18 months）. There were no great vessels,trachea, esophagus or spinal cord iatrogenic injury. There were no pull out and breakage of screws or plates. Fusion was achieved in all patients at an average of 12 weeks after operation. There was no pseudarthrosis of bone union. Among all the patients,96.3% got complete reduction and the normal intervertebral height and lordosis were maintained. The patients with complete spinal cord had no neurologic recovery, but they felt relief from upper limb pain or numb. Incomplete spinal cord lesions was improved on average 1 -2 Frankel grade after surgery. Conclusion Using suitable operative route according to different types of injuries can get satisfactory anatomy reestablishment in the treatment of fracture and dislocation of lower cervical spine combined with spinal cord injury.

关 键 词：颈椎 脱位 外科手术 脊髓损伤 

分 类 号：R683.2[医药卫生—骨科学] R651.21[医药卫生—外科学]