颅骨牵引联合自制复位工具颈前路手术治疗下颈椎骨折脱位合并关节突交锁的效果  

Effect of intraoperative skull traction plus self-made reduction tool in anterior cervical surgery on lower cervical fracture and dislocation combined with articular process interlocking

作　　者：杨理强 贺海怿 李想[1] 李鹏[1] 聂富祥[1] 张凯[1] 张鹏飞[1] 郭高升 郭强[1] 董晨 YANG Li-qiang;HE Hai-yi;LI Xiang;LI Peng;NIE Fu-xiang;ZHANG Kai;ZHANG Peng-fei;GUO Gao-sheng;GUO Qiang;DONG Chen(Department of Spinal Surgery,Sanmenxia Central Hospital,Sanmenxia,Henan 472000,China)

机构地区：[1]三门峡市中心医院脊柱外科,河南三门峡472000

出　　处：《中华实用诊断与治疗杂志》2022年第10期1029-1033,共5页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的观察颈前路手术采用颅骨牵引联合自制复位工具治疗单节段下颈椎骨折脱位合并关节突交锁的复位情况及神经功能改善情况,探讨其临床疗效。方法单节段下颈椎骨折脱位合并关节突交锁患者42例,均行一期颈前路减压复位+Cage植骨融合内固定术,术中采用颅骨牵引联合自制复位工具。术后随访6~12个月,术前、末次随访时评估美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级;术前、术后1周及末次随访时行CT、X线及MRI检查,评价Cobb角变化、脊髓神经减压情况及关节突交锁复位情况;术前、术后1周及末次随访时评价颈椎功能障碍指数(neck disability index,NDI)和疼痛视觉模拟评分(visual analogue scale,VAS)。结果42例患者手术均顺利完成,无颈动脉、椎动脉及食管等破裂损伤;均获得满意复位,其中39例完全复位,3例未完全复位。1例术后因高位脊髓神经损伤出现呼吸心跳骤停、抢救无效死亡;1例术后并发重症肺炎,治疗效果差自动出院;余40例患者随访6~12(7.5±0.3)个月。42例患者术前ASIA分级A级2例(包括1例死亡),B级7例(包括1例自动出院),C级16例,D级13例,E级4例。除死亡及自动出院患者,其余40例末次随访时1例A级患者无变化,6例B级患者转为C级1例、D级5例,16例C级患者转为D级7例、E级9例,13例D级患者均转为E级,4例E级患者无变化。40例患者术后1周及末次随访时Cobb角[(3.91±1.22)°、[(4.24±1.13)°]均大于术前[(1.80±0.74)°](P<0.05),末次随访时Cobb角大于术后1周(P<0.05);术后1周及末次随访时NDI评分[(32.17±13.79)、(14.00±6.45)分]、VAS评分[(3.50±1.34)、(1.13±0.79)分]均低于术前[(56.78±17.50)、(6.17±1.38)分](P<0.05),末次随访时NDI评分、VAS评分均低于术后1周(P<0.05)。40例患者末次随访时行颈椎X线及CT检查,显示骨折脱位复位良好,内固定位置良好,颈椎序列恢复良好;行颈椎MRI检查,显示脊髓神经减压充�Objective To observe the replacement and nervous function improvement after skull traction plus self-made reduction tool in anterior cervical surgery on lower cervical fracture and dislocation combined with articular process interlocking, and to investigate the clinical effect. Methods Forty-two patients with single segmental lower cervical fracture and dislocation combined with articular process interlocking were treated with one-stage anterior cervical decompression + Cage bone graft fusion and internal fixation. Skull traction combined with self-made reduction tool was used in surgery. All patients were followed up for 6 to 12 months. The American Spinal Cord injury Association(ASIA) grade was evaluated before operation and at the final follow-up. CT, X-ray and MRI were performed before operation, 1 week after operation and at the final follow-up to evaluate the changes of Cobb angle, spinal cord nerve decompression and interlocking reduction of articular process. Neck disability index(NDI) and visual analogue score(VAS) were evaluated before operation, 1 week after operation and at the final follow-up. Results All patients completed the operation successfully, without rupture of carotid artery, vertebral artery and esophagus. A satisfactory reduction was achieved, including 39 patients of complete reduction and 3 patients of incomplete reduction. One patient died of respiratory and cardiac arrest due to high spinal cord nerve injury after operation.One patient was complicated with severe pneumonia after operation and withdrew treatment due to poor efficacy.The other 40 patients were followed up for 6 to 12(7.5±0.3)months.Of 42 patients,ASIA grade before operation was A in 2 patients(including 1 death),B in 7(including 1 voluntary discharge),C in 16,D in 13 and E in 4.Except for death and voluntary discharge,in the final follow-up of 40 patients,the patient in grade A had no change;6 patients were in grade B,in which 1 was changed to grade C and 5 were changed to grade D;16 patients were in grade C,in which 7

关 键 词：下颈椎骨折脱位 关节突交锁 单节段 颅骨牵引 复位 颈前路手术 

分 类 号：R687.3[医药卫生—骨科学]