一期后前路手术治疗下颈椎关节突脱位后畸形愈合的疗效分析  

One-stage posterior-anterior combined operation for treatment of abnormal fusion after facet joint dislocation in subaxial cervical spine

作　　者：康永生[1] 刘沛霖[1] 苏锴 王庆德[1] 郭润栋[1] 姜文涛[1] 张振辉[1] 邵哲 梅伟[1] Kang Yongsheng;Liu Peilin;Su Kai;Wang Qingde;Guo Rundong;Jiang Wentao;Zhang Zhenhui;Shao Zhe;Mei Wei(Department of Spine Surgery,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院脊柱外科,郑州450052

出　　处：《中华创伤骨科杂志》2024年第1期85-88,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨一期后前路手术治疗下颈椎关节突脱位后畸形愈合的疗效。方法回顾性分析2015年1月至2023年5月郑州市骨科医院收治的10例下颈椎关节突脱位后畸形愈合患者资料。男7例,女3例;年龄(41.2±3.1)岁;脊髓损伤按美国脊髓损伤协会(ASIA)分级:A级5例,B级4例,C级1例。所有患者均采用一期后前路手术治疗。记录患者手术时间、术中出血量,应用ASIA分级评估术后3个月的脊髓神经功能改善情况。比较患者术前、术后3个月及末次随访时疼痛视觉模拟评分(VAS)、颈椎椎间隙高度和Cobb角,术后3个月采用Bridwell椎间融合标准评估椎间植骨融合情况,观察并发症发生情况。结果所有患者术后获15.5(13.8,20.5)个月随访。手术时间为(119.5±3.6)min,术中出血量为(141.6±25.6)mL。术后3个月及末次随访时的VAS、颈椎椎间隙高度和Cobb角均较术前显著改善,差异均有统计学意义(P<0.05),以上指标术后3个月与末次随访时比较差异均无统计学意义(P>0.05)。术后3个月ASIA分级:A级4例,B级4例,C级2例。术后3个月Bridwell椎间融合标准:Ⅰ级9例,Ⅱ级1例;椎间融合良好。所有患者手术顺利,术后无神经损伤加重、血管损伤等并发症发生。结论一期后前路手术治疗下颈椎关节突脱位后畸形愈合,能够减轻疼痛,恢复颈椎间隙高度和生理曲度,椎间融合好,疗效确切。Objective To investigate the efficacy of one-stage posterior-anterior combined operation for the treatment of abnormal fusion after facet joint dislocation in the subaxial cervical spine.Methods A retrospective study of case series was conducted to analyze the clinical data of 10 patients with abnormal fusion after facet joint dislocation in the subaxial cervical spine who had been admitted to Department of Spine Surgery,Zhengzhou Orthopedic Hospital from January 2015 to May 2023.There were 7 males and 3 females with an age of(41.2±3.1)years.Preoperative American Spinal Injury Association(ASIA)grading:5 cases of grade A,4 cases of grade B,and 1 cases of grade C.All the patients were treated with one-stage posterior-anterior combined operation.The surgical time and intraoperative bleeding volume were recorded.The ASIA grading was used to evaluate the improvements in nerve function of the spinal cord 3 months after surgery.The VAS scores,cervical intervertebral heights,and Cobb angles were compared between pre-surgery,3 months after surgery,and the last follow-up.The fusion of intervertebral bone graft was evaluated 3 months after surgery using the Bridgell intervertebral fusion criteria.Complications were observed.Results All patients were followed up for 15.5(13.8,20.5)months.The surgical time was(119.5±3.6)minutes,and the intraoperative bleeding volume(141.6±25.6)mL.Significant improvements in VAS score,cervical intervertebral height,and Cobb angle were observed at 3 months after surgery and the last follow-up compared with the pre-surgery values(P<0.05),but there was no statistically significant difference between 3 months after surgery and the last follow-up(P>0.05).ASIA grading 3 months after surgery:4 cases of grade A,4 cases of grade B,and 2 cases of grade C.By the Bridgell intervertebral fusion criteria at 3 months after surgery:9 cases of gradeⅠand 1 cases of gradeⅡ,showing good intervertebral fusion.Surgery went on well for all patients,showing no postoperative complications such as aggravation of

关 键 词：颈椎 椎关节突关节 关节脱位 畸形愈合 

分 类 号：R687.3[医药卫生—骨科学]