手术治疗严重上颈椎骨折脱位的疗效分析  

Effect analysis of the surgery treatment of severe cervical spine fracture dislocation

作　　者：张东[1] 陈敬忠[1] 罗肖[1] 

机构地区：[1]内江市第二人民医院骨科,四川内江641000

出　　处：《临床骨科杂志》2016年第4期404-407,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨手术治疗严重上颈椎骨折脱位的临床疗效和应用价值。方法采用前后路手术以及颈椎前路钢板和后路钉棒枕颈融合联合复位技术治疗32例严重上颈椎骨折脱位患者。前后路联合手术均在颅骨牵引下经鼻腔气管插管全身麻醉下进行,患者先采用俯卧位,后路植入侧块螺钉、减压、复位,恢复颈椎的序列,植骨融合后拆除颅骨牵引改置仰卧位行前路减压、植骨及自锁钛板固定。术后定期复查X线片观察损伤节段的稳定性和融合率,以Frankel分级判定脊髓神经功能的恢复情况。结果 Frankel分级除6例A级者及3例D级者外,其余患者均有1-2级提高,其中9例达到E级。32例中有3例于术后1个月内死亡,29例获得6-32个月随访。脱位均完全复位,无植骨不融合。损伤节段稳定,颈椎椎间高度及生理曲度都得到良好重建及维持,未出现内固定断裂、松动及脱出,无血管、神经、食道损伤等并发症。结论颈椎前后路联合手术治疗严重上颈椎骨折脱位,能完全恢复颈椎序列,损伤节段术后获得即刻稳定,方便术后护理和功能锻炼,有利于脊髓功能恢复。Objective To explore the clinical curative effect of surgery treatment of severe cervical spine fracture dislocation and application value. Methods Thirty-two cases of severe cervical spine fracture dislocation were treated by anterior cervical plate and posterior screw rod occipital cervical fusion joint reduction technology via anterior and posterior approach. Posterior joint are performed under the skull traction by nasal tracheal intubation under general anesthesia,prone position,firstly used in patients with posterior lateral mass screws implanted,decompression,reduction,restored cervical sequence,demolition of skull traction changed after bone graft fusion supine anterior decompression,bone graft and locking titanium plate fixation. Postoperative X-ray film was used to obeserve damage stability and the convergence rate of the section,Frankel classification was used to determine functional recovery of spinal cord injury. Results Except for grade A 6 cases and grade D 3 cases,patients were grade 1 - 2 improvement. Nine patients had recovered to grade E. Three patients of 32 patients died in one month postopertation,the orther 29 cases were followed up for 6 - 32 months. Dislocation were completely reset,no bone graft fusion occurred.Damage segmental stability,cervical intervertebral height and physiological curvature were good maintenance and reconstruction,no internal fixation of fracture,loose and out was present,no complications such as blood vessels,nerves,injury of the esophagus were found. Conclusions The combined anterior cervical fixation for the treatment of upper cervical fracture and dislocation has advantages of full restoration of cervical series,good reduction,canal pressure before and after the parties have to completely remove,damage to obtain immediate stability after segments to facilitate post-operative care and functional training,favorable functional recovery of spinal cord,which is a positive and effective way.

关 键 词：颈椎骨折脱位 前后路 脊髓损伤 内固定 

分 类 号：R683.2[医药卫生—骨科学] R684.7[医药卫生—外科学]