自制颈椎前路撑开复位器在颈椎脱位伴关节突交锁手术治疗中的应用  

Self-made anterior cervical distraction and reduction device for the treatment of lower cervical dislocation with facet locked

作　　者：牛国旗[1] 刘路坦 聂虎[1] 周功[1] 张井泉[1] 汪东[2] 陈辉[1] 刘涛[1] 孙正[1] 刘振华[2] Niu Guoqi;Liu Lutan;Nie Hu;Zhou Gong;Zhang Jingquan;Wang Dong;Chert Hui;Liu Tao;Sun Zheng;Liu Zhenhua(Department of Orthopedics,the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233040,China)

机构地区：[1]蚌埠医学院第二附属医院骨科,安徽省蚌埠市233000 [2]蚌埠医学院第一附属医院骨科

出　　处：《中华解剖与临床杂志》2018年第5期412-417,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的 探讨应用自制颈椎前路撑开复位器(ACDR)治疗下颈椎脱位伴关节突交锁的可行性及临床疗效.方法 采用回顾性研究.分析2008年5月—2018年5月应用自制颈椎前路撑开复位器(ACDR)治疗下颈椎脱位伴关节突交锁患者25例,其中男16例、女9例,年龄25~73岁;单侧关节突交锁6例,双侧关节突交锁19例.术中采用ACDR进行前路解锁复位,复位成功后行前路椎间盘切除减压、植骨融合钛板内固定术.观察手术时间、术中出血量、手术前后神经功能变化、脱位纠正、住院时间、植骨融合等情况,以综合评估手术疗效.结果 25例患者手术时间50~90(79±8.7)min,术中出血50~200(130±67)mL,住院时间5~13(7.0±2.1)d,均一期解剖复位,前路融合.获随访22例患者,平均随访时间11.5个月(6~24个月),植骨融合良好钢板螺丝钉无松动,神经动能均获得不同程度的恢复.JOA评分由术前平均(5.7±1.55)分,术后3月增加至(13.6±1.74)分,经配对t检验,术前术后JOA评分差异有统计学意义(t=22.468,P<0.01).1例术后出现一过性双上肢感觉运动功能障碍加重,2周内恢复至术前水平.3例残留有双手轻度麻木,握力稍弱.13例神经功能恢复至ASIA E级,6例恢复至ASIA D级,3例恢复至ASIA C级.结论 应用颈椎前路撑开复位器ACDR治疗下颈椎脱位伴关节突交锁,可一次性完成减压、解锁、复位、植骨内固定手术.ACDR撑开复位安全、有效、可靠性高,是一种较好的手术工具,有一定临床应用价值.Objective To explore the feasibility and clinical effect of self-made anterior cervical distraction and reduction device (ACDR)in the treatment of lower cervical dislocation with facet locked. Methods From May 2008 to May 2018 a retrospective analysis was done on 25 cases of lower cervical dislocation combined with facet locked who were treated by self-made anterior cervical distraction and reduction device (ACDR)in Department of Orthopedics,the Second Affiliated Hospital of Bengbu Medical College.There were 16 males and 9 females with a mean age of 45.9 years (range,25-73 years old). There were 6 cases of unilateral locked facet and 19 cases of bilateral locked facet of lower cervical spine. After successful restoration,anterior intervertebral disc resection and decompression,bone grafting and titanium plate internal fixation were performed.The operative time,intraoperative blood loss,neurological function changes before and after surgery,dislocation correction,average hospitalization days,bone graft fusion and other conditions were recorded to evaluate the surgical efficacy.Results All the 25 patients underwent one stage anatomic reduction and anterior fusion.The operative time was 50-90(79±8.7)min, and intraoperative blood loss was 50-200(130±67)mL,and the hospital stays was 5-13(7±2.1)d. Twenty-two patients were followed up,and the mean follow-up time was 11.5 months (6-24months),the bone graft and fusion were good,the plates and screws were not loosened,and the nerve function got better in all patients.The JOA score increased from an average of 5.7 points before surgery to 13.6 points at 3 months after surgery.One of the patients developed a transient upper limbs sensorimotor dysfunction and recovered to the preoperative level within 2 weeks.Three patients were left with mild numbness of hands and weak grip strength.Thirteen cases of neurological function recovered to ASIA E grade,6 cases returned to grade D,and 3 cases returned to grade C.Conclusions ACDR is a safe,effective and reliable surgical tool fo

关 键 词：脊柱融合术 下颈椎 脱位 关节突交锁 颈椎前路撑开复位器 

分 类 号：R687.3[医药卫生—骨科学]