Ⅰ期前后路联合手术治疗复杂下颈椎骨折脱位伴关节突绞锁  

I-stage combination operation of anterior and posterior approaches for complicated lower cervical spine fracture and dislocation combined with facet dislocation

作　　者：陆林[1] 叶哲伟[1] 安颍 吴星火[1] 王金龙[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《临床外科杂志》2016年第11期875-878,共4页Journal of Clinical Surgery

基　　金：武汉市科技攻关资助项目(201260523172-11)

摘　　要：目的：探讨Ⅰ期前后路联合手术在复杂下颈椎骨折脱位伴关节突绞锁中的临床疗效。方法Ⅰ期采用颈椎前路减压＋钢板内固定与后路减压＋椎弓根钉内固定联合治疗复杂下颈椎骨折脱位伴关节突绞锁28例，其中单侧关节突绞锁10例，双侧关节突绞锁18例。美国脊柱损伤协会（ASIA）分级 A 级2例，B 级6例，C 级14例，D 级6例；日本骨科协会评估治疗（JOA）评分平均为（7.2±2.4）分。对所有患者治疗前后的病情恢复程度进行评价。结果术后所有患者均无血管、喉返喉上神经及食管等周围组织损伤，复查 X 线片显示脱位完全复位27例，不完全复位1例。随访6~24个月，平均15个月，所有患者的内固定物均未出现断裂、松动，植骨愈合良好，未见假关节形成，颈椎椎间高度及生理曲度都得到的不同程度的重建及维持。ASIA 分级及 JOA评分基本均有所提高，其中 A 级1例，B 级4例，C 级8例，D 级6例，E 级9例；JOA 评分平均为（15.7±3.0）分。结论Ⅰ期前后路联合手术治疗复杂下颈椎骨折脱位伴关节突绞锁可前后充分减压，促进患者的神经功能恢复，是治疗复杂下颈椎骨折脱位伴关节绞锁的有效手术治疗方式。Objective To explore the clinical curative effect and application value of I-stage combination operation of anterior and posterior approaches for complicated lower cervical spine fracture and dislocation combined with facet dislocation. Methods A total of 28 patients were treated with I-stage fixation via anterior and posterior approaches,including 10 cases of unilateral facet dislocation and 18 ca-ses of bilateral facet dislocation. According to the standards of ASIA,there were 2 cases of grade A,6 ca-ses of grade B,14 cases of grade C,6 cases of grade D. The average JOA score is（7. 2 ± 2. 4）points. Re-covery of all patients was evaluated after treatment. Results There were no neurovascular and esophagus complications during the operation in all patients. The results of X-ray film showed completely reduction in 27 cases. The follow-up duration ranged from 6 months to 24 months,with an average of 15 months. No looseness or breakage was detected in the fixation system. Kyphosis（Cobb angle）,vertebral body transla-tion,vertebral body height and interbody fusion were almost normal. No false joints,bone nonunion,appar-ent titanium mesh collapse occurred. Neurologic function recovery was achieved in major cases,including 1 case of ASIA grade A,4 cases of grade B,8 cases of grade C,6 cases of grade D and 9 cases of grade E. The postoperative JOA score was（15. 7 ± 3. 0）point. Conclusion The I-stage combination operation of anterior and posterior approaches for fracture and dislocation of the cervical spine can significantly improve spinal cord function,which is an effective method.

关 键 词：前后路联合 关节突绞锁 脊髓损伤 下颈椎骨折脱位 

分 类 号：R687.3[医药卫生—骨科学]