植入物与Halo-vest内外固定联合治疗下颈椎骨折脱位  

Combined therapy of implants internal fixation and Halo-vest external fixation for the treatment of subaxial cervical fracture-dislocation

作　　者：姚关锋[1] 王新家[1] 罗滨[1] 王伟东[1] 曾机灿[1] 

机构地区：[1]汕头大学医学院第二附属医院骨科,广东省汕头市515041

出　　处：《中国组织工程研究》2013年第35期6351-6356,共6页Chinese Journal of Tissue Engineering Research

基　　金：高校博士点专项科研基金新教师类(20124402120004);汕头市科技计划项目(E201100393)~~

摘　　要：背景:对于外伤性下颈椎骨折脱位及脊髓损伤,选择何种治疗方式目前尚存争议。目的:评价植入物内固定与Halo-vest外固定联合应用治疗下颈椎骨折脱位后稳定性的临床效果。方法:回顾分析汕头大学医学院第二附属医院骨科2009年1月至2011年12月收治下颈椎骨折脱位的17例患者,男13例,女4例,年龄21-65岁,平均年龄41.6岁,高处坠落伤6例,重物压砸伤3例,道路交通伤8例,伤后入院时间2h-5d,平均2.5d,所有患者均在局麻下行Halo-vest外固定,然后逐步撑开,在复位情况下,行前路减压植骨、钛板螺钉内固定,通过Frankel分级与影像学检查评价治疗效果。结果与结论:所有患者获得随访,随访12-24个月,平均15.4个月,常规X射线正侧位片显示骨折脱位均复位,恢复颈椎的正常序列及生理弧度,CT显示植骨融合,未发现内固定断裂及松动,按Frankel分级,显效(降低2级)5例,有效(降低1级)10例,无效2例。植入物与Halo-vest内外固定联合对下颈椎骨折脱位失稳固定的效果不仅安全可靠,并且能更好的恢复脊柱的矢状位对线。BACKGROUND： There is controversial in choosing the treatment method for the treatment of traumatic subaxial cervical fracture-dislocation and spinal cord injury. OBJECTIVE： To evaluate the clinical effect of implant internal fixation and Halo-vest external fixation on the stability after treatment of subaxial cervical fracture-dislocation. METHODS： A retrospective analysis was conducted on 17 patients with subaxial cervical fracture-dislocation in the Department of Orthopedics, the Second Affiliated Hospital of Shantou University Medical College between January 2009 to December 2011, including 13 male patients and 4 female patients, the age was ranged from 21-65 years, average 41.6 years. There were six cases of high falling injury, three cases of crush injury and eight cases of traffic accident injury. The hospitalization time after injury was 2 hours to 5 days, average 2.5 days. All the patients received Halo-vest external fixation under local anesthesia, then distraction gradually, and received anterior decompression graft and titanium screw fixation under reduction. The treatment effect was evaluated through Frankel classification and imaging examination. RESULTS AND CONCLUSION： All the patients were followed-up for 12-24 months, average 15.4 months. Normal anteraposterior X-ray film showed fracture reduction, the cervical vertebra restored to the normal sequence and physiological curvature; CT showed graft fusion without internal fixation fracture and loosing; according to Frankel classification, marked effect （decreased for 2 grade） in five cases, effective （decreased for 1 grade） in 10 cases, and ineffective in two cases. Implant internal fixation combined with Halo-vest external fixation issafe and reliable in thb^instability fixation of subaxial cervical fracture-dislocation, and can better restore the spinal sagittal alignment.

关 键 词：骨与关节植入物 骨与关节学术探讨 颈椎骨折 骨折脱位 前后路 椎弓根螺钉 内固定 Halo-vest外固定 HALO-VEST支架 脊柱植入物 骨性融合 生物力学 并发症 其他基金 

分 类 号：R318[医药卫生—生物医学工程]