治疗下颈椎骨折脱位伴脊髓损伤的三种手术方式  

Three different surgical approaches in the treatment of fracture and dislocation of the lower cervical spine combined spinal cord injury

作　　者：刘勇[1] 张国华[1] 兰天亮[1] 李文龙[1] 赵春成 任海霞[1] 

机构地区：[1]陕西宝鸡市中心医院骨科,721008

出　　处：《中国矫形外科杂志》2015年第16期1461-1464,共4页Orthopedic Journal of China

摘　　要：[目的]探讨三种手术方式治疗下颈椎骨折脱位伴脊髓损伤的临床效果。[方法]2009年6月~2012年6月根据损伤情况分别对116例下颈椎骨折脱位伴脊髓损伤患者采用不同手术方式,行脊髓减压,恢复颈椎序列、生理曲度并植骨融合内固定,其中36例前路手术,28例后路手术,52例前后路联合手术。术前美国脊髓损伤学会（ASIA）评分：A级18例,B级23例,C级34例,D级41例。对平均Cobb角、椎体间滑移距离及术后神经功能恢复情况进行分析。[结果]三种手术各组内术前、术后Cobbe角,椎体间滑移距离及JOA评分差异均有统计学意义,三组间术前Cobbe角,椎体间滑移距离及JOA评分比较差异均无统计学意义,但末次Cobb角、椎体间滑移距离及JOA评分,联合组分别与前路组或后路组比较差异有统计学意义,前路组与后路组比较差异无统计学意义。[结论]三种手术方式均有效果,应根据具体伤情选择,前后路联合手术能最大限度恢复颈椎序列,解除脊髓前后方压迫并使损伤节段牢靠固定,为脊髓恢复创造条件。[ Objective] To investigate the clinical effects of three different surgical approaches in the treatment of fracture and dislocation of the lower cervical spine combined spinal cord injury. [ Method] A retrospective review of 116 patients with fracture and dislocation of the lower cervical spine combined spinal cord injury were treated by different approches based on fracture types From June 2009 to June 2012. Patients underwent surgical decompression, restore cervical sequence, physiological curvature, bone graft and internal fixation. Anterior group had 36 cases, posterior group 28 cases, the combined set of 52 eases. According to American Spinal Injury Association （ASIA） grades,18 cases were in A grode,23 cases in B grade,34 eases in C grade and 41 cases in D grade. The average Cobb angle intervertebral forward slip away and neurological improvement were ana- lyzed. [Result] There were statistical difference about average Cobb angle, intervertebral forward slip away and JOA scores with- in each group,there was not significant differences among three groups before operation. But in the last follow - up, there was significant difference between the combined treatment group and anterior or posterior group. There was no significant difference between anterioror and posterior group. [ Conclusion ] Three surgical methods are effective. It is important to select a suitable surgical approach according to different types of cervical fracture. Combined anterior and posterior can give a completely decom- pression and internal fixation, it could recover the cervical sequence and obtain good reduction. The injured segments can gain postoperative immediate stability. This technique is benefit to the patients for the functional recovery of the spinal cord.

关 键 词：颈椎 骨折脱位 脊髓损伤 

分 类 号：R687.3[医药卫生—骨科学]