不同治疗方法对下颈椎骨折脱位合并关节突绞锁患者的影响  

Effects of different treatment methods on patients with fracture and dislocation of lower cervical vertebra combined with facet interlocking

作　　者：贾金龙 王朝阳[1] 沈彦 JIA Jinlong;WANG Chaoyang;SHEN Yan(Department of Orthopedics,The 72nd Group Military Hospital of the Chinese PLA Land Force,Huzhou 313000,China)

机构地区：[1]中国人民解放军陆军第七十二集团军医院骨五科,浙江湖州313000

出　　处：《全科医学临床与教育》2020年第6期526-530,F0002,共6页Clinical Education of General Practice

基　　金：湖州市科学技术局自然科学资金项目(2016YZB03)。

摘　　要：目的观察单纯前路手术、后路手术及前后路联合手术对下颈椎骨折脱位合并关节突绞锁患者治疗后的恢复情况的影响。方法选择下颈椎骨折脱位合并关节突绞锁患者78例,根据患者病情分为前路手术组、后路手术组和前后路联合手术组,各26例。比较三组患者的手术时间、术中出血量;观察患者术前、术后颈椎X线,比较测量椎间隙高度及Cobb角;采用颈椎JOA评分标准及Frankel脊髓损伤分级法对三组术后患者的神经功能恢复情况进行评价。结果三组患者复位手术中,前路手术组术中出血量和手术时间均最少,后路手术组次之,前后路联合手术组最多,差异均有统计学意义(F分别=228.59、356.76,P均<0.05)。三组患者术后颈椎椎间隙高度、Cobb角和颈椎JOA评分与术前比较,均有明显改善(t分别=-13.75、-11.62、-7.75;-10.60、-14.23、-4.45;-9.90、-13.00、-4.81,P均<0.05)。术后三组间颈椎椎间隙高度、Cobb角和颈椎JOA评分比较,差异均无统计学意义(F分别=0.37、1.37、1.07,P均>0.05)。三组患者术后6个月神经功能恢复Frankel分级评分均较术前有所提升(t=-8.76,-10.69,-13.12,P均<0.05),三组术前术后患者神经功能恢复Frankel分级评分比较,差异均无统计学意义(F分别=0.24、0.43,P均>0.05)。结论前路手术可以直接处理椎间盘损伤;后路手术可以处理椎体后部结构损坏严重,前后联合入路可以同时处理颈椎骨折脱位和椎间盘损伤,需根据下颈椎骨折脱位合并关节突绞锁患者损伤类型及全身状态,制定个体化的可行手术方案,可以获得满意疗效。Objective To observe the influence of simple anterior surgery,posterior surgery and combined anterior and posterior surgery on patients with fracture and dislocation of lower cervical spine combined with articulations locked.Methods Totally 78 cases of fracture and dislocation of lower cervical vertebra combined with articular process were selected and divided into anterior surgery group,posterior surgery group,and combined group,with 26 cases in each.The operative time and intraoperative hemorrhage among three groups were compared.The cervical X-ray before and after surgery was observed,and intervertebral space height and Cobb angle were compared.The neurological recovery of three groups was evaluated by cervical JOA score and Frankel spinal cord injury grading.Results The intraoperative hemorrhage in the anterior surgery group was least and operation time was shortest among three groups,and the posterior surgery group was the second,the combined group was the most(F=228.59,356.76,P<0.05).The postoperative cervical intervertebral height,Cobb angle and cervical JOA score of the three groups were significantly improved compared with those of the preoperative(t=-13.75,-11.62,-7.75,-10.60,-14.23,-4.45,-9.90,-13.00,-4.81,P<0.05).There were no significant difference in cervical intervertebral space height,Cobb angle and cervical JOA score among three groups after surgery(F=0.37,1.37,1.07,P>0.05).The Frankel classification of neurological recovery of three groups were improved after surgery(t=-8.76,-10.69,-13.12,P<0.05),but there was no significant difference in Frankel classification score before and after surgery among three groups(F=0.24,0.43,P>0.05).Conclusion Anterior surgery is suitable for the damage of intervertebral disc.Posterior surgery is suitable for the severe posterior structural damage of the vertebral body,while combined anterior and posterior approaches can simultaneously deal with cervical fracture and dislocation and disc injury.Individualized and feasible surgical plans should be formulated accordi

关 键 词：下颈椎骨折脱位关节突绞锁 颈椎 骨折 脱位 脊髓 神经功能 

分 类 号：R687.3[医药卫生—骨科学]