陈旧性下颈髓损伤的手术治疗  

Surgical treatment for old lower cervical spinal cord injury

作　　者：孙国栋[1] 李志忠[1] 王晶[1] 林永新[1] 焦根龙[1] 隋杰[1] 周志刚[1] 

机构地区：[1]暨南大学附属第一医院骨科,广州510632

出　　处：《中国矫形外科杂志》2012年第2期105-107,共3页Orthopedic Journal of China

摘　　要：[目的]探讨陈旧性下颈髓损伤的手术方式和疗效。[方法]2005年1月～2009年12月,共收治陈旧性下颈椎损伤并引起颈脊髓或神经根损伤的患者39例,所有患者均为伤后1个月以上。手术方式包括前路减压复位、椎体间植骨融合钢板内固定术与前后路联合减压复位内固定术。通过术后颈椎的稳定性、植骨融合率及神经功能恢复情况进行评价。[结果]20例患者获得解剖复位,19例患者复位达到80%以上,术后平均随访32个月。植骨完全融合,无假关节、骨不连发生,颈椎椎间高度、生理曲度及颈椎稳定性维持良好。术后ASIA的感觉及运动评分较术前明显提高。所有患者术中无神经损害加重及血管损伤等并发症发生。[结论]陈旧性下颈椎骨折脱位引起的颈脊髓损伤的治疗应按照脱位程度及脊髓损伤程度选择不同手术方案,手术治疗能够恢复颈椎的序列和高度、解除脊髓压迫,改善神经功能。[ Objective] To evaluate the methods and efficacy of surgical treatment of spinal cord injury caused by old fracture and dislocation of cervical vertebrae. [ Method ] A retrospective study was performed in 39 patients with old fracture and dislocation of cervical vertebrae, who received operative treatment between January 2005 and December 2009. The time from injury to hospitalization was delayed for mote than one month. All patients received open reduction, internal fixation, and iliac bone graft spinal fusion. Single anterior operation was performed in 28 and combined anterior and posterior approach operation in 11. Postoperative cervical spine stability, bone graft fusion rate and nerve function recovery were observed. [ Result ] Anatomic re- duction was achieved in 20 and reduction to 80% was obtained in 19 paticnts. The average time of follow-up was 32 months. Solid fusion was obtained in all patients during the follow-up. The normal intervertebral height and lordosis, and the stability of centrum were maintained. All cases showed significant increase in ASIA score of motion and pin prick at the final follow-up compared with that before operation. There were no complications of neurological function deterioraion or blood vessel injuries. [ Conclusion] An peration regimen for old cervical spinal cord injury should be determined by the neurologic status of the pa- tient, and the severity of the injury and the dislocation. For old fracture or dislocation of cervical vetebrae, surgicnl treatment is effective. It can obtain satisfactory reduction, decompression and stability.

关 键 词：颈椎 脊髓损伤 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]