可调式颈椎牵引器复位颈椎脱位的效果  

Effects of the adjustive tractor in treatment of cervical dislocation

作　　者：陈仲[1] 陈科[2] 靳安民[1] 周初松[1] 陈银海[1] 张积利 宋德勇 

机构地区：[1]南方医科大学珠江医院骨科, 广州510282 [2]广西中医药大学附属瑞康医院脊柱科 [3]新疆哈密地区中心医院骨科 [4]广东佛山市禅城区中心医院

出　　处：《中华骨科杂志》2012年第7期693-697,共5页Chinese Journal of Orthopaedics

基　　金：广东省科技计划项目（20118031300005）,广州市海珠区科信局产学研重点项目（20111100189）

摘　　要：目的观察可调式颈椎牵引器复位颈椎骨折脱位的临床效果。方法回顾性分析2007年9月至2011年11月治疗47例颈椎骨折脱位患者资料，男36例，女11例；年龄7-62岁，平均35岁。伤后到就诊时间0．5-72h，平均8．6h。脱位节段：寰枕关节2例，C1．2 2例，C2．3 5例，C3．4 2例，C4.5 9例，C5.6 13例，C6，7 14例；其中30例伴骨折。16例无关节突绞锁，10例为单侧关节突绞锁，21例为双侧关节突绞锁。根据美国脊髓损伤学会（American Spinal Injury Association，ASIA）分级标准，术前A级4例，B级10例，C级18例，D级10例，E级5例。根据日本骨科学会（Japanese Orthopaedic Association，JOA）评分标准，术前JOA评分为2-14分，平均9分。采用可调式颈椎牵引器复位，复位后行支具或内固定治疗。结果47例患者均成功复位，无一例发生神经损伤加重。牵引重量为7-60kg，平均25．6kg；牵引时间为3-10min，平均8min。术后随访时间为6-48个月，平均38个月。所有椎体排列、椎间高度均恢复正常；椎体间植骨全部融合，融合时间3-6个月，平均3．3个月；1例椎弓骨折患者术后1年仍未愈合，但无特殊不适，未再处理。末次随访时ASIA分级：A级3例，B级1例，C级4例，D级8例，E级31例；JOA评分为2-17分，平均12分。结论可调式颈椎牵引器使用简便、安全，可实现即时复位，且复位成功率高。Objective To observe the clinical effects of the adjustive tractor for cervical dislocation. Methods Forty-seven patients were included between September 2007 and November 2011. There were 36 males and 11 females with age ranged from 7 to 62 （mean, 35 years）. The mean interval from injury to admission was 8.6 h （range, 0.5-72 h）. There were atlanto-occipital dislocation in 2 cases, C1,2 in 2 cases, C2,3 dislocation in 5 cases, C3.4 dislocation in 2, C4.5 in 9, C5.6 in 13, C6.7 in 14. Thirty cases were complicated by fracture. No facet locking occurred in sixteen cases. Facet locking was found in ten cases and bilateral facet locking was in 21 cases. After reduction, brace or internal fixation followed. According to American Spinal Injury Association （ASIA） spinal function impairment scale standard, there were 4 cases in level A, 10 cases in level B, 18 in C, 10 in D, and 5 in E. According to Japanese Orthopaedic Association （JOA） spinal function rating standard, the mean JOA score was 9 （range, 2-14）. Results All 47 cases were reduced successfully without neuronal function aggravation. Traction power ranged from 7 to 60 kg （mean, 25.6 kg）, the mean time of traction was g min （range, 3-10 min）. The mean follow-up was 38 （range, 6-48） months. All the patients achieved normal alignment and intervertebral height. The intervertebral body fusion was observed in all of cases, the mean fusion time was 3.3 months （range, 3-6 months）. One patient who experienced nonunion of vertebral arch fracture didn＇t receive further treatment because of absence of symptoms. At last follow-up, there were 3 cases in level A, 1 in level B, 4 in C, 8 in D, and 31 in E according to ASIA scale. The mean JOA score was 12 （range, 2-17）. Conclusion The adjustive tractor is simple and safe for prompt reduction.

关 键 词：颈椎 脱位 骨折 牵引术 

分 类 号：R687.3[医药卫生—骨科学]