颈前路两种复位方式治疗下颈椎关节突绞锁性椎体骨折伴脱位的临床效果  

Clinical effect of two anterior cervical reduction methods in the treatment of interlocking vertebral fracture with dislocation of lower cervical articular process

作　　者：吴永乐[1] 郑南生[2] 黄田[1] 张育专 李涛 林鸿亮[1] WU Yong-le;ZHENG Nan-sheng;HUANG Tian;ZHANG Yu-zhuan;LI Tao;LIN Hong-liang(Department of Orthopaedics,Second People’s Hospital of Hainan Province,Wuzhishan Hainan 572299,China;Department of Orthopaedics,Hainan Hospital of Traditional Chinese Medicine,Haikou Hainan 570203,China)

机构地区：[1]海南省第二人民医院骨科,海南五指山572299 [2]海南省中医院骨科,海南海口570203

出　　处：《局解手术学杂志》2022年第9期808-812,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的 探讨颈前路两种复位方式在手术治疗下颈椎关节突绞锁性椎体骨折伴脱位中的临床应用效果。方法 回顾性分析128例下颈椎关节突绞锁性椎体骨折伴脱位患者的临床资料,患者按手术复位方式的不同分为提拉组(67例)和撬拨组(61例),提拉组于提拉螺钉及撑开器辅助下复位后行颈前路减压植骨融合,撬拨组采用前路撑开撬拨复位固定方式进行治疗。比较2组患者围术期情况、治疗后神经功能恢复情况、影像学参数变化及并发症发生情况。结果 2组患者手术时间、切口长度、术中出血量、术中透视次数、住院时间比较差异均无统计学意义(P> 0.05)。2组患者去除外固定时间与完全负重时间比较差异无统计学意义(P> 0.05)。2组患者术后6个月及术后12个月美国脊髓损伤协会(ASIA)运动功能评分及感觉功能评分、JOA颈椎评分较术前均明显提高,且提拉组各项评分高于撬拨组,差异均有统计学意义(P <0.05)。2组患者颈椎前弧度、C2~C7前凸角及局部成角发生显著变化,组内差异有统计学意义(P <0.001),同一时间点组间差异无统计学意义(P> 0.05)。2组患者术后并发症总发生率比较,差异有统计学意义(P <0.05)。结论 提拉螺钉及撑开器辅助复位与撬拨复位后前路减压植骨融合内固定治疗下颈椎关节突绞锁性椎体骨折伴脱位疗效明确,但前者复位更有效,中远期神经根功能恢复更佳。Objective To investigate the clinical application effect of two anterior cervical reduction methods in the surgical treatment of interlocking vertebral fracture with dislocation of lower cervical articular process. Methods The clinical data of 128 patients of interlocking vertebral fracture with dislocation of lower cervical articular process were retrospectively analyzed,the patients were divided into the lifting group( 67 cases) and the prying group( 61 cases) according to different surgical reduction methods. The lifting group underwent anterior cervical decompression and bone graft fusion after reduction assisted by lifting screws and spreaders,and the prying group underwent anterior distraction,prying,reduction and fixation. The perioperative conditions,neurological function recovery after treatment,changes of imaging parameters and incidence of complications were compared between the two groups. Results There was no statistically significant difference in the operation time,incision length,intraoperative blood loss,intraoperative fluoroscopy times,or hospital stay between the two groups( P > 0. 05). There was no statistically significant difference in the time of external fixation removal or the time of full weight-bearing between the two groups( P > 0. 05). The motor and sensory function scores of American Spinal Injury Association( ASIA) and JOA cervical vertebra scores 6months and 12 months after operation of the two groups were significantly higher than those before operation,and the scores of the lifting group were higher those of the prying group,the difference were statistically significant( P < 0. 05). The anterior cervical curvature,C2to C7lordosis angle and local angulation of patients in the two groups changed significantly,and the difference within the group was statistically significant( P < 0. 001),but there was no significant difference between the groups at the same time point( P > 0. 05). There was a statistically significant difference in the incidence of postoperative complications betwee

关 键 词：颈椎 骨折 脱位 关节突关节 颈前路手术 内固定 

分 类 号：R683[医药卫生—骨科学] R61[医药卫生—外科学]