前路椎体次全切与后前路手术治疗陈旧性下颈椎骨折脱位的疗效比较  

Treatment of old cervical spine fracture dislocation： anterior subtotal vertebrectomy, titanium mesh bone graft fusion and internal fixation VS posterior anterior solution plus anterior discectomy cage bone graft fusion and internal fixation

作　　者：钱立雄[1] 郝定均[1] 刘团江[1] 郑永宏[1] 何立民[1] 许正伟[1] 王栋琪[1] 

机构地区：[1]西安交通大学医学部附属红会医院脊柱外科颈椎病区,710054

出　　处：《美中国际创伤杂志》2017年第1期14-17,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的：比较前路椎体次全切钛网植骨融合内固定术与后前路松解＋前路间盘切除cage植骨融合内固定术治疗陈旧性下颈椎骨折脱位的疗效。方法：回顾性分析2006年12月至2014年1月收治的56例陈旧性下颈椎骨折脱位患者的临床资料，按手术方式分为前路椎体次全切钛网植骨融合内固定术组（AC组）和后前路松解＋前路间盘切除cage植骨融合内固定术组（PA组），AC组26例，PA组30例。两组患者年龄、性别比、病程、随访时间、术前VAS评分、手术节段分布均无统计学差异（P〉0．05）。比较两组患者手术时间、术中出血量，随访患者神经功能改善情况，不同时间点颈部疼痛VAS评分、术后并发症和植骨融合情况。结果：PA组手术时间、术中出血量明显大于AC组（P〈0．05）。AC组和PA组术后神经功能改善率分别为92％（24／26）和90％（27／301，差别无统计学意义（P〉0．05）。AC组和PA组VAS评分术后1w和术后1年随访时均较术前明显降低（P〈0．05），术后1w和术后1年随访时，PA组VAS评分较AC组明显降低（R0．05）。两组患者术后6—12个月所有患者均获得骨性融合，末次随访时，无螺钉松动、钛板断裂、融合器或钛网移位脱落等情况发生。结论：前路椎体次全切钛网植骨融合内固定术和后前路松解＋前路间盘切除cage植骨融合内固定术治疗陈旧性下颈椎骨折脱位均能获得满意的神经功能改善率，前者术中出血量和手术时间明显少于后者，后者在缓解颈部疼痛方面有一定的优势。Objective： To compare the clinical effects of anterior subtotal vertebrectomy, titanium mesh bone graft fusion, internal fixation and posterior anterior solution plus anterior discectomy, cage bone graft fusion, internal fixation for treatment of old cervical spine fracture and dislocation. Methods： From December 2006 to January 2014, the clinical data of 56 patients with old lower cervical spine fracture and dislocation was analyzed respectively. According to the surgery approach, all cases were divided into two groups： anterior subtotal vertebrectomy, titanium mesh bone graft fusion, internal fixation group （group A, 26 cases） and posterior anterior solution plus anterior discectomy, cage bone graft fusion, internal fixation group （group B, 30 cases）. There was no statistic difference in patients＇ age, gender, course of disease, time of follow-up, preoperative VAS scores of neck pain and distribution of operated segments between two groups （P〉0.05）. The operation time, intraoperative blood loss, improvement of neural function, VAS scores, complications and fusion rate of bone graft in all patients was evaluated and compared postoperatively. Results： There was no difference between group A （92%, 24/26） and group B （90%, 27/30） in neural improvement （P〉O.05）. In aspect of operation time and intraoperative blood loss, group B was longer and more than group A （P〈0.05）. At 1 week and 1 year follow-up visits, an obvious decrease noted in VAS score （P〈0.05）, especially in group B, which was more than group A （P〈0.05）. All patients obtained a bony union 6-12 months after operation, and no screw loosing, plate breakage, cage or titanium mesh displacement occurred at the final follow-up. Conclusion： Both anterior subtotal vertebreetomy, titanium mesh bone graft fusion, internal fixation and posterior anterior solution plus anterior discectomy, cage bone graft fusion, internal fixation for treatment of old eervical spine fracture dislocation can get a satisfactory

关 键 词：颈椎 骨折脱位 陈旧性 外科手术 

分 类 号：R683.2[医药卫生—骨科学]