基于CT二维图像的分类复位手术治疗下颈椎单节段关节突脱位  

Classified reduction based on CT two‑dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine

作　　者：康永生[1] 梅伟 王庆德[1] 郭润栋[1] 刘沛霖[1] 姜文涛[1] 张振辉[1] 苏锴 邵哲 宋亚 王坤[2] Kang Yongsheng;Mei Wei;Wang Qingde;Guo Rundong;Liu Peilin;Jiang Wentao;Zhang Zhenhui;Su Kai;Shao Zhe;Song Ya;Wang Kun(Department I of Spine Surgery,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China;Fifth Clinical College of Henan University of Chinese Medicine(People′s Hospital of Zhengzhou),Zhengzhou 450002,China)

机构地区：[1]郑州市骨科医院脊柱一科,郑州450052 [2]河南中医药大学第五临床学院(郑州人民医院),郑州450002

出　　处：《中华创伤杂志》2023年第4期331-340,共10页Chinese Journal of Trauma

摘　　要：目的探讨基于CT二维图像的分类复位手术治疗下颈椎单节段关节突脱位的疗效。方法采用回顾性病例系列研究分析2015年1月至2022年10月郑州市骨科医院收治的105例下颈椎单节段关节突脱位患者临床资料,其中男63例,女42例;年龄22~78岁[(47.5±3.6)岁]。术前美国脊髓损伤协会(ASIA)分级:A级23例,B级45例,C级22例,D级15例,E级0例。基于CT二维图像,根据下颈椎前后结构是否连续,后方关节突有无活动进行手术入路分类。下颈椎前后结构连续及后方关节突可活动,行颈椎前路手术;下颈椎前后结构连续性中断或后方关节突融合,行后路关节突切除术加颈椎前路手术。根据上关节突下角的位置对关节突脱位进行分型,并选择相应的复位技术:A型位于背侧,给予颅骨牵引或手法复位;B型位于顶端,给予颅骨牵引加撬拨复位;C型位于腹侧,给予颅骨牵引加撬拨助推复位。如果同1例患者的两个关节突脱位存在不同类型,按照C型>B型>A型的原则优先处理。记录关节突复位成功率、手术时间、术中出血量。比较术前、术后3个月及末次随访时颈椎椎间隙高度和Cobb角以评估颈椎生理曲度。术后3个月采用Lenke分级评估椎间植骨融合率。术前及术后3个月应用ASIA分级评估脊髓神经损伤的改善情况。术前及术后3个月应用日本骨科学会(JOA)评分评估颈部脊髓功能障碍程度,并根据末次随访评分结果计算术后颈部脊髓功能改善率。观察并发症发生情况。结果患者均获随访3~9个月[(6.0±2.5)个月]。关节突复位成功率为100%。手术时间为40~95 min[(58.6±9.3)min],术中出血量为40~120 ml[(55.7±6.8)ml]。术后3个月及末次随访时颈椎椎间隙高度分别为(4.7±0.3)mm、(4.7±0.2)mm,较术前的(3.1±0.5)mm显著改善(P均<0.01);术后3个月与末次随访时颈椎椎间隙高度差异无统计学意义(P>0.05)。术后3个月及末次随访时颈椎Cobb角分别为(6.5�Objective To investigate the efficacy of the classified reduction based on CT two‑dimensional images for the surgical treatment of single segment facet joint dislocation in subaxial cervical spine.Methods A retrospective case series study was made on 105 patients with single segment facet joint dislocation in subaxial cervical spine admitted to Zhengzhou Orthopedic Hospital from January 2015 to October 2022.There were 63 males and 42 females,with the age range of 22‑78 years[(47.5±3.6)years].Preoperative American Spinal Cord Injury Association(ASIA)classification was grade A in 23 patients,grade B in 45,grade C in 22,grade D in 15 and grade E in 0.The classification of surgical approach was based on the presence or not of continuity between anterior and posterior subaxial cervical structures and the movability of the posterior cervical facet joint on CT two‑dimensional images,including anterior cervical surgery if both were presented and posterior facet joint resection plus anterior cervical surgery if there was discontinuity between anterior and posterior subaxial cervical structures or posterior facet joint fusion.Reduction procedures were applied in accordance with the type of facet joint dislocation classified based on the position of the lower upper corner of facet joint,including skull traction or manipulative reduction for the dislocation locating at the dorsal side(type A),intraoperative skull traction and leverage technique for the dislocation locating at the top(type B)and intraoperative skull traction and leverage technique with boosting for the dislocation locating at the ventral side(type C).If the dislocation of two facet joints in the same patient was different,the priority of management followed the order of type C,type B and type A.The reduction success rate,operation time and intraoperative blood loss were recorded.The cervical physiological curvature was evaluated by comparing the intervertebral space height and Cobb angle before operation,at 3 months after operation and at the last foll

关 键 词：颈椎 椎关节突关节 关节脱位 CT 

分 类 号：R687.3[医药卫生—骨科学]