全身麻醉后手法牵引复位联合颈前路椎间盘切除减压融合术治疗下颈椎绞锁脱位的疗效分析  

Manual reduction under general anesthesia and anterior cervical discectomy and fusion for treatment of cervical locked facet dislocation

作　　者：李中麒 李淼[1,3] 曹勇[1,3] 段春岳[1,3] 吴建煌[1,3] 胡建中[1,2,3] 吴天定 Li Zhongqi;Li Miao;Cao Yong;Duan Chunyue;Wu Jianhuang;Hu Jianzhong;Wu Tianding(Department of Orthopaedic Spine Surgery and Orthopaedics,Xiangya Hospital,Central South University,Changsha 410008,China;Hunan Provincial Key Laboratory of Organ Injury,Aging and Regenerative Medicine,Changsha 410008,China;National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科脊柱外科,长沙410008 [2]器官损伤衰老与再生医学湖南省重点实验室,长沙410008 [3]中南大学湘雅医院,国家老年疾病临床医学研究中心,长沙410008

出　　处：《中华创伤骨科杂志》2022年第7期577-582,共6页Chinese Journal of Orthopaedic Trauma

基　　金：湖南省自然科学基金(2020JJ5930);湖南省科技创新计划项目(2021ZK4220);中南大学研究生教改课题(512190131)。

摘　　要：目的探讨全身麻醉后手法牵引复位联合颈前路椎间盘切除减压融合术(ACDF)治疗下颈椎绞锁脱位的疗效。方法回顾性分析2019年1月至2020年12月中南大学湘雅医院骨科脊柱外科收治的53例外伤性下颈椎单节段脱位合并单/双侧关节突关节绞锁患者资料。男36例,女17例;年龄18~64岁,平均45.5岁。患者均在神经电生理监测下行手法牵引复位联合ACDF治疗,通过观察并发症,并比较手术前、后的美国脊髓损伤协会(ASIA)分级、改良的日本骨科协会(mJOA)评分和颈椎功能障碍指数(NDI)评估疗效。结果所有患者术后随访16~30个月(平均24个月),术后切口无感染,均一期愈合。患者术后出现谵妄2例,腹胀9例,下肢深静脉血栓形成4例,中枢性尿崩1例。术后影像学资料显示所有患者均实现颈椎序列复位,椎间骨性融合,无内固定物松脱。末次随访时患者的脊髓功能ASIA分级与术前相比,总体改善率为84.9%(45/53),VAS评分(2.0±0.5)分、mJOA评分(13.1±3.1)分、NDI指数(16.6±5.9)与术前[(7.5±1.5)分、(6.9±3.5)分、37.8±7.8]比较均显著改善,差异有统计学意义(P<0.05)。结论充分评估患者损伤状态的前提下,全身麻醉后在神经电生理监测下手法牵引复位联合ACDF是治疗单节段下颈椎骨折脱位合并关节突绞锁的安全、有效的方式。Objective To investigate the clinical efficacy of manual reduction under general anesthesia combined with anterior cervical discectomy and fusion(ACDF)in the treatment of lower cervical locked facet dislocation.Methods Retrospectively analyzed were the data of 53 patients with traumatic single segment dislocation of lower cervical spine combined with single/bilateral facet articular lock who had been admitted to Department of Orthopaedic Spine Surgery,Xiangya Hospital,Central South University from January 2019 to December 2020.There were 36 males and 17 females,aged from 18 to 64 years(average,45.5 years).All the patients were treated with ACDF under neuroelectrophysiological monitoring.Clinical efficacy was assessed by observing complications and comparing American Spinal Injury Association(ASIA)grading,Modified Japanese Orthopaedic Association(mJOA)scores,neck disability index(NDI)and visual analogue scale(VAS)before and after surgery.Results All patients were followed up for 16 to 30 months(mean,24 months).All incisions healed by primary intention with no infection after operation.There were 2 cases of delirium,9 cases of abdominal distension,4 cases of lower extremity venous thrombosis,and one case of central diabetes insipidus.Postoperative imaging data showed that all patients achieved sequential reduction of the cervical spine,intervertebral bony fusion,and no internal fixation loosening.The last follow-up showed that the overall improvement rate of ASIA grading of spinal cord function was 84.9%(45/53)compared with the preoperation and that the VAS score(2.0±0.5),mJOA score(13.1±3.1)and NDI index(16.6±5.9)were significantly improved compared with the preoperative values(7.5±1.5,6.9±3.5,and 37.8±7.8)(P<0.05).Conclusion On the premise of fully assessing the patient's injury status,manual reduction under general anesthesia combined with ACDF is a safe and effective treatment of single-level lower cervical fracture combined with facet dislocation.

关 键 词：颈椎 脊柱骨折 脱位 手法复位 

分 类 号：R614.2[医药卫生—麻醉学]