合并关节突交锁的下颈椎骨折脱位的前路手术  

Anterior surgical procedures for lower cervical fracture and dislocation accompanied with locked facets

作　　者：唐辉 徐永清 尹德宏 彭玉峰 范新宇 冉朝雄 宋祖富 汤迅 李春晓 周田华 TANG Hui;XU Yong-qing;YIN De-hong;PENG Yu-feng;FAN Xin-yu;RAN Chao-xiong;SONG Zu-fu;TANG Xun;LI Chun-xiao;ZHOU Tianhua(Institute of Traumatic Orthopaedic,The 920 th Hospital,Joint Logistic Support Force of CPLA,Kunming 650032,China;The First People's Hospital of Xichou County,Wenshan663500,China)

机构地区：[1]解放军联勤保障部队第920医院全军创伤骨科研究所,云南昆明650032 [2]云南省文山自治州西畴县第一人民医院,云南文山663500

出　　处：《中国矫形外科杂志》2023年第3期279-282,共4页Orthopedic Journal of China

基　　金：云南省创伤骨科临床医学中心资助项目(云南省卫健委临床中心建设重大项目)(编号:ZX20191001)。

摘　　要：[目的]评价屈曲牵引下前路手术复位、减压和融合固定关节突交锁下颈椎骨折脱位的临床效果。[方法]2015年1月—2019年1月,采用屈曲牵引,前路开放复位,减压融合固定治疗关节突交锁下颈椎骨折脱位患者45例,男33例,女12例;年龄29~64岁,平均(48.6±7.2)岁。采用NDI、JOA评分、ASIA分级,以及影像检查评估临床效果。[结果]45例患者均顺利完成手术,关节突复位成功率为100.0%,手术时间平均(65.4±22.8)min,切口长度平均(6.1±0.9)cm,术中出血量平均(290.9±90.0)ml。随访时间平均(2.7±1.1)年,随时间推移,NDI和JOA评分,以及ASIA评级较均显著改善(P<0.05),均未出现脊髓损伤加重表现。影像方面,与术前相比,术后椎间高度颈椎前凸Cobb角显著改善(P<0.05)。未发现内固定物松动、移位、断裂等现象。[结论]屈曲牵引单纯前路复位、减压融合内固定术可有效治疗合并关节突交锁的下颈椎骨折脱位。[Objective]To evaluate the clinical outcomes of anterior surgical procedures,involving reduction,decompression and in⁃strumented fusion under flexion traction for cervical fracture and dislocation accompanied with locked facets.[Methods]From January 2015 to January 2019,45 patients,including 33 males and 12 females aged from 29 to 64 years with a mean of(48.6±7.2)years,underwent anterior surgical procedures,involving reduction,decompression and instrumented fusion under flexion traction for cervical fracture and dislocation accompanied with locked facets.Clinical outcomes were assessed by using NDI and JOA scores,ASIA scale,as well as radio⁃graphs.[Results]All the 45 patients had the operations completed successfully,with facet reduction rate of 100.0%,operation time of(65.4±22.8)min,incision length of(6.1±0.9)cm,intraoperative blood loss of(290.9±90.0)ml.As time went during the follow-up period lasted for(2.7±1.1)years,the NDI and JOA scores,as well as ASIA grades improved significantly(P<0.05).No patients showed any wors⁃ening of spinal cord injury during the follow-up period.Radiographically,the intervertebral height of the affected disc and the Cobb angle of cervical lordosis significantly improved postoperatively compared with those preoperatively(P<0.05).No loosening,displacement or frac⁃ture of the internal implant was found in anyone of them until the latest follow up.[Conclusion]The anterior surgical procedures,involving reduction,decompression and instrumented fusion,under flexion traction do effectively treat the lower cervical fracture and dislocation ac⁃companied with locked facets.

关 键 词：下颈椎骨折脱位 关节突交锁 颅骨牵引 颈前路手术 

分 类 号：R683.2[医药卫生—骨科学]