下颈椎关节突交锁脱位的治疗策略  

Strategy for surgical treatment of lower cervical spine with facet joint dislocation

作　　者：付青松[1] 王安全[1] 周宇[1] 于海洋[1] 李超[1] 

机构地区：[1]阜阳市人民医院骨科,安徽236004

出　　处：《中国骨与关节损伤杂志》2015年第9期902-905,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨下颈椎关节突交锁脱位的损伤特点与治疗策略。方法回顾性分析自2010-09—2013-06诊治的32例下颈椎关节突交锁脱位的临床资料。测量矢状位X线片上椎体水平位移(HD)及椎体间角度变化(AD),术前32例交锁节段HD 2.1~6.2 mm,平均4.3 mm,AD-4.2°^-17.4°,平均-8.6°。术前均行颅骨牵引试行复位。新鲜单侧交锁脱位14例,前路手术10例,前后路联合手术1例,后路手术3例;新鲜双侧关节突交锁脱位15例,前路手术8例,前后路联合手术4例,后路手术3例;陈旧性双侧交锁脱位3例分期前后路手术。结果 32例获18~36个月,平均22.4个月的随访。X线片显示椎间融合全部获得骨性愈合,愈合时间10~14周,平均11.6周。末次随访时采用Mc Grory颈椎创伤评分标准对术后疗效进行评价:优14例,良4例,可4例,差10例,优良率56.3%;影像学评价:术后32例HD 0~1.2 mm,平均0.06 mm,AD 0°~12.4°,平均7.4°。稳定31例,轻度不稳定1例。结论对于下颈椎关节突交锁脱位的治疗,术前应全面评估损伤情况,根据损伤特点选择最佳的治疗方案,以促进神经功能最大程度的恢复。Objective To evaluate injury characteristics and treatment strategy of the lower cervical spine with facet joint dislocation. Methods Thirty two cases of the lower cervical spine with facet joint dislocation from Sept. 2010 to Jun. 2013 were retrospectively reviewed. The horizontal displacement and angular displacement were measured on the sagittal X-ray to evaluate the severity of the facet joint dislocation. Preoperative ground lock segment HD was 2.1-6.2 mm, the average 4.3mm, AD 4.2°-17.4°, an average of 8.6°. Preoperative skull traction was employed for trial reduction. Of 14 cases with fresh unilateral facet joint dislocation, 10 cases received anterior operation, 1 case anterior-posterior operation, 3 cases posterior operation. Of 15 cases with fresh bilateral facet joint dislocation, 8 cases received anterior operation, 4 cases anterior-posterior operation, 3 cases posterior operation. Three cases of old bilateral facet joints dislocation received staged anterior-posterior operations. Results The mean follow-up period was 22.4 months（18-36 months）. Postoperative X-ray showed that bone fusion was achieved in all patients within 11.6 weeks（10-14 weeks）. Mc Grory cervical trauma scoring criteria was used to evaluate postoperative curative effect in the last follow-up. Clinical evaluation： 14 cases superior,4 cases good, 4 cases fair,10 cases poor; good rate 56.3%. Radiography evaluation： postoperatively 32 cases＇ HD mean 0.06 mm（1-1.2 mm） and AD7.4°（0°-12.4°）. Thirty one cases were stable, 1 case was mild unstable. Conclusion The damage of the low cervical spine with facet joint dislocation should be assessed comprehensively before operation based on the characteristics of damage. The best treatment strategy can be selected to promote the recovery of neural function to the greatest extent.

关 键 词：下颈椎关节突交锁脱位 颅骨牵引 内固定 治疗策略 

分 类 号：R687.3[医药卫生—骨科学]