下颈椎屈曲分离型损伤的临床特点与手术选择  

Clinical characteristics and surgical options of distractive flexion injuries in lower cervical spine

作　　者：龙浩[1] 肖杰[1] 郭涛[1] 陈艺新[1] 邹伟[1] 吴陈[1] 

机构地区：[1]贵阳市第四人民医院脊柱外科,贵州550002

出　　处：《创伤外科杂志》2012年第1期24-26,共3页Journal of Traumatic Surgery

摘　　要：目的探讨下颈椎屈曲分离型损伤的临床特点与手术选择。方法回顾性分析2007年1月～2010年12月收治的有随访资料的25例下颈椎屈曲分离型损伤病例。其中新鲜损伤(﹤11d)15例,5例出现脊髓损伤,4例出现神经根损伤;陈旧性损伤(1个月～25年)10例均出现明显的颈痛及不同程度脊髓压迫或者神经根刺激症状。15例新鲜损伤患者中11例牵引复位后行前路手术,4例复位失败者行前后路切开复位手术;10例陈旧性损伤患者均采用前路脱位椎下方椎体次全切除术。结果 25例术后随访平均13个月(6～21个月),15例新鲜损伤有9例合并脊髓及神经根损伤,其中7例完全恢复。10例陈旧性损伤中8例患者颈痛及脊髓压迫神经根牵拉症状完全消失。X线片及CT提示椎体间融合好,颈椎生理曲度恢复满意。结论新鲜下颈椎屈曲分离型损伤患者应积极通过牵引或者手术复位,根据术前复位情况决定手术方式。陈旧性患者可不作勉强复位,通过脱位椎下方椎体次全切除亦能达到神经组织减压的目的 。Objective To discuss the clinical characteristics of distractive flexion injuries in lower cervical spine and to give suggestion on surgical options. Methods Retrospective study was performed on 25 patients with distractive flexion injuries in lower cervical spine admitted from Jan. 2007 to Dec. 2010. There were 15 cases of fresh injury ,including 5 cases of spinal cord injuries,4 cases of nerve root injuries. There were 10 cases of old injuries ,all of whom complained of neck pain and neurological dysfunction. Preoperative reduction was achieved in 11 cases of fresh injuries,followed by anterior discectomy and fusion. Reduction failed in the other 4 cases and then they underwent anterior-posterior surgeries. Ten cases of old injuries underwent anterior corpectomy （ the vertebra adjacent to the dislocated vertebrae）. Results The average follow-up was 13 months （6-21 months） in this group. Seven cases of fresh injuries and 8 cases of old injuries, who complained of preoperative neurological impairment, achieved total neu- rological function recovery. Radiological examinations showed that anticipated intervertebral body fusion and alignment of cervical spine were achieved. Conclusion For fresh distractive flexion injury, preoperative reduction should be firstly considered. And the surgical options should be based on the reduction. For old injuries ,reduction is not mandatory, and anterior corpectomy may be a good option for decompression of neurological elements.

关 键 词：颈椎脱位 手术 

分 类 号：R684.7[医药卫生—骨科学]