前后路联合手术治疗严重颈椎骨折脱位  

Combined anterior and posterior approach for severe cervical fractures and dislocation

作　　者：陈扬[1] 张伟彬[1] 杨欣建[1] 曾腾辉[1] 蓝涛[1] 任凯[1] 杨泽雨[1] 夏晓龙 

机构地区：[1]深圳市第二人民医院脊柱外科,广东518000

出　　处：《中国骨与关节损伤杂志》2015年第7期680-682,共3页Chinese Journal of Bone and Joint Injury

基　　金：深圳市科技计划项目(CXZZ20140414170821148);深圳市卫生计生系统科研项目(201401016)

摘　　要：目的 通过观察颈椎前后路联合手术固定治疗严重颈椎骨折脱位的临床疗效。方法 自2013-03—2014-06采用前后路联合手术治疗严重颈椎骨折脱位23例,定期X线片观察损伤节段的稳定性和融合率,以JOA评分、ASIA分级了解脊髓功能恢复情况。结果 所有患者获得随访6~12（9.0±2.5）个月,颈椎前后路联合手术固定后,损伤节段稳定,四肢感觉较术前明显改善,术后各关键肌肌力平均增加1或2级。术后ASIA分级均达到D级以上,JOA评分由术前（6.4±0.9）分提高到末次随访时（13.3±2.4）分,差异有统计学意义（P〈0.05）,颈髓功能术后得到改善。结论 采用颈椎前后路联合手术固定严重颈椎骨折脱位可使损伤节段获得早期稳定,利于脊髓功能恢复。Objective To investigate the clinical effects of combined anterior and posterior approach decompression and internal fixation for severe cervical fractures and dislocation. Methods From March 2013 to June 2014, 23 patients with severe cervical fractures and dislocation were selected to undergo the combined anterior and posterior approach. The stability and fusion of the injured segments were observed on the X-ray films. The function of the spinal cord was evaluated with JOA score and ASIA score. Results This group were followed up for 6-12 months, mean foUow-up time was （9±2.5）months. The injured segments were stable after combined anterior and posterior approach, the feelings of limbs compared with preoperative ones were improved distinctly, and the postoperative strength of key muscles increased by 1 or 2 levels. Postoperative ASIA score achieved D level above, mean JOA score improved from （6.4±0.9） before operation to （13.3±2.4） at last follow-up, which showed significant differences with the preoperative ones （P 〈0.05）. Spinal cord recovery was improved. Conclusion The immediate stability of the injured segments would be obtained by the combined anterior and posterior internal fixation in the patients with severe cervical fractures and dislocation. And the anterior and posterior approach could promote the recovery of spinal cord.

关 键 词：颈椎 骨折 脱位 脊髓损伤 内固定 

分 类 号：R687.3[医药卫生—骨科学]