下颈椎骨折脱位的手术治疗方法探讨  

Internal Fixation for the Fracture and Dislocation of the Lower Cervical Spine

作　　者：张庆林[1] 李江[1] 纪军[1] 袁正兵[1] 涂青虹[1] 

机构地区：[1]广东省东莞市桥头医院骨科,广东东莞523538

出　　处：《实用骨科杂志》2010年第5期329-332,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨下颈椎骨折脱位手术方法及其疗效。方法回顾性分析自2004年10月至2009年8月共收治的48例下颈椎骨折脱位手术治疗病例,所有患者术前均行X线、CT和MRI检查,入院时ASIA脊髓损伤分级,A级5例,B级15例,C级14例,D级9例,E级5例。其中行前路手术39例,前后联合入路手术6例,前-后-前入路3例。结果48例均获得6个月-4年随访,平均随访26个月。根据ASIA脊髓损伤分级评分,合并颈脊髓损伤患者神经功能均得到良好改善,48例术后末次随访A级3例,B级3例,C级12例,D级15例,E级15例。结论下颈椎骨折脱位,根据影像学评估,确定骨折脱位类型与脊髓受压损伤部位和程度,采用单纯前路、前后联合入路或前-后-前入路手术治疗可获得满意的复位和减压,重建颈椎的稳定性,缩短治疗期,利于早期康复锻炼,神经功能有不同程度的良好改善。Objective To look into the modality and the effect of surgery for the patients with fracture and dislocation of the lower cervical spine.Methods A retrospective clinical study of 48 patients with fracture and dislocation of the lower cervical spine who underwent surgical treatment from Oct,2004 to Aug,2009.All patients took X-ray,CT,MRI.According to American Spinal Injury Association（ASIA） grades to the patients′ spinal injury at the admission to the hospital,there were 5 cases in Grade A,15 cases in Grade B,14 cases in Grade C,9 cases in Grade D,5 cases in Grade E.39 cases underwent anterior surgeries while 6 cases underwent combination of anterior and posterior surgeries,and 3 cases underwent anterior-posterior-anterior approach.Results 48 patients were followed up from 6 months to 4 years,averaged of 26 months.According to American Spinal Injury Association（ASIA） grades,all the 48 patients′ neural function complicated with cervical spinal injury got improvement at the last follow-up：3 cases in Grade A,3 cases in Grade B,12 cases in Grade C,15 cases in Grade D,15 cases in Grade E.Conclusion For the patients with fracture and dislocation of the lower cervical spine,the type of injury,the involved spinal level and degree could be diagnosed according to the radiographic manifestation.The surgical modalities including anterior,combination of anterior and posterior,and anterior-posterior-anterior approach could get satisfied reduction and decompression.They could reconstitute the cervical stabilization and shorten the therapeutic period which were good for early habilitation and various improvement of neural function.

关 键 词：下颈椎 骨折 脱位 手术治疗 疗效 

分 类 号：R683.2[医药卫生—骨科学]