前路手术治疗无脊髓损伤的Allen-Ferguson Ⅱ度及Ⅲ度下颈椎损伤  

EFFECTIVENESS AND SAFETY OF SIMPLY ANTERIOR APPROACH FOR LOWER CERVICAL SPINE FRACTURE DISLOCATION(Allen-Ferguson Ⅱ OR Ⅲ TYPE) WITHOUT SPINAL CORD INJURY

作　　者：朱延明 岳二松 孔权威 

机构地区：[1]河南省煤炭总医院骨科,郑州450003

出　　处：《中国修复重建外科杂志》2016年第11期1408-1411,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨前路手术治疗无脊髓损伤的Allen-FergusonⅡ、Ⅲ度下颈椎骨折脱位的临床疗效和安全性。方法 2013年6月-2015年6月,采用单纯经前路减压、复位及椎间植骨融合内固定术治疗25例无脊髓损伤的Allen-FergusonⅡ、Ⅲ度下颈椎骨折脱位患者。男17例,女8例;年龄31~57岁,平均41.2岁。致伤原因：高处坠落伤11例,摔伤5例,砸伤6例,交通事故伤3例。新鲜骨折24例,陈旧性骨折1例。神经功能Frankel分级：D级6例,E级19例。损伤节段：C4、5 5例,C5、6 14例,C6、7 6例。关节突交锁：单侧9例,双侧16例。记录手术时间、术中出血量及并发症发生情况,采用Odom标准评价临床疗效。X线片复查,观测Cobb角、D值（颈椎后凸或前凸程度）的变化及植骨融合情况。结果 患者均顺利完成手术;手术时间66~115 min,术中出血量80~220 m L。25例均获随访,随访时间12~36个月,平均19.3个月。术后1例发生一过性吞咽困难,2例发生供骨区疼痛;无其他并发症发生。术前神经功能Frankel D级者均于3个月内恢复至E级。X线片复查示植骨均融合;颈椎间高度无丢失,未发生内植物松动、断裂。术后3个月参照Odom标准评价临床疗效,获优18例,良6例,可1例,优良率96.0%。术后Cobb角和D值均较术前显著改善（P〈0.05）;术后即刻、6周、3个月、6个月间比较差异均无统计学意义（P〉0.05）。结论 单纯经前路手术治疗无脊髓损伤的Allen-FergusonⅡ、Ⅲ度下颈椎骨折脱位患者临床疗效好,安全性高,创伤小,术后康复快。ObjectiveTo study the effectiveness and safety of simply anterior approach for lower cervical spine fracture dislocation （Allen-Ferguson II or III type） without spinal cord injury. MethodsTwenty-five patients with lower cervical spine fracture dislocation （Allen-Ferguson II or III type） without spinal cord injury were treated between June 2013 and June 2015. There were 17 males and 8 females with an average age of 41.2 years （range, 31-57 years）. Injury was caused by falling from height in 11 cases, by bruise in 5 cases, by crash of heavy object in 6 cases, and by traffic accident in 3 cases. There were 24 cases of fresh fractures and 1 case of old fracture. According to the Frankel grading criteria, 19 cases were rated as grade E and 6 cases as grade D. The injured levels included C4, 5 in 5 cases, C5, 6 in 14 cases, and C6, 7 in 6 cases. Unilateral locked-facet joint was observed in 9 cases, and bilateral locked-facet joint in 16 cases. The operation time, intraoperative blood loss, and surgical complications were recorded; the Odom standard was used to evaluate the effectiveness. The Cobb angle and D-value （the degree of cervical kyphosis or lordosis） were measured on the X-ray film, the bone graft fusion rate was recorded. ResultsThe operation was successfully completed in 25 patients; the operation time was 66 to 115 minutes, the intraoperative blood loss was 80 to 220 mL. The postoperative follow-up time was 12 to 36 months （mean, 19.3 months）. Postoperative temporary dysphagia occurred in 1 case, and pain at donor site in 2 cases; there were no complications of spinal cord injury, hematoma, hoarse, and esophageal fistula. The nerve function was improved from preoperative grade D to postoperative grade E at 3 months. The X-ray films showed bone graft fusion; there was no loss of intervertebral height or loosening of internal fixation. At 3 months after operation, the effectiveness was excellent in 18 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 96.0%. T

关 键 词：颈椎 骨折脱位 关节突交锁 脊髓损伤 前路手术 

分 类 号：R687.3[医药卫生—骨科学]