下颈椎骨折脱位脊髓损伤的前路与后路手术比较  

Anterior reduction and instrumented fusion versus posterior counterpart for lower cervical spine fractures and dislocations with spinal cord injury

作　　者：张金磊[1] 杨高彬 朱彦谕 ZHANG Jin-lei;YANG Gao-bin;ZHU Yan-yu(Department of Orthopaedics,Zhoukou Central Hospital,Zhoukou 466000,China)

机构地区：[1]周口市中心医院骨科,河南周口466000

出　　处：《中国矫形外科杂志》2024年第16期1467-1473,共7页Orthopedic Journal of China

摘　　要：[目的]比较前路与后路减压复位融合内固定治疗下颈椎骨折脱位(lower cervical spine fracture and dislocation,LCSFD)合并脊髓损伤(spinal cord injury,SCI)的临床疗效。[方法]回顾性分析2018年9月—2022年8月收治的LCSFD合并SCI 80例患者的临床资料,根据医患沟通结果,40例采用前入路,40例采用后入路。对比两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术,前路组在手术时间[(95.0±10.4)min vs(123.5±13.6)min,P<0.001]、切口总长度[(3.5±0.6)cm vs(11.2±2.0)cm,P<0.001]、术中透视次数[(3.6±1.2)次vs(6.5±1.5)次,P<0.001]、术中失血量[(96.2±14.6)ml vs(254.5±30.5)ml,P<0.001]、术后引流量[(40.2±8.7)ml vs(66.0±12.4)ml,P<0.001]、住院时间[(8.2±2.6)d vs(12.5±3.8)d,P<0.001]及完全负重活动时间[(74.2±12.0)d vs(83.5±14.6)d,P=0.003]均显著优于后路组。随时间推移,两组VAS、NDI、JOA评分及ASIA分级均显著改善(P<0.05)。前路组术后3个月VAS评分[(2.0±0.4)vs(2.4±0.5),P<0.001]、NDI[(26.1±5.3)vs(29.0±5.6),P=0.020]和JOA评分[(13.6±2.3)vs(12.3±2.1),P=0.010]以及末次随访时VAS评分[(1.5±0.3)vs(1.7±0.4),P=0.013]均显著优于后路组。影像方面,术后两组局部后凸角、伤椎滑移、椎间隙相对高度、责任段椎管面积均较术前显著改善(P<0.05)。术后7 d前路组局部后凸角[(4.2±0.8)°vs(5.0±1.6)°,P=0.006]、伤椎滑移[(2.0±0.4)mm vs(2.4±0.6)mm,P<0.001]均显著小于后路组,末次随访时,前路组伤椎滑移[(2.1±0.5)mm vs(2.5±0.9)mm,P=0.016]仍显著小于后路组。[结论]前路复位融合内固定治疗LCSFD合并SCI具有创伤小、术后恢复快的优点,更有利于脊髓神经功能恢复。[Objective]To compare the clinical outcomes of anterior reduction and instrumented fusion versus posterior counterpart for lower cervical spine fractures and dislocations(LCSFD)with spinal cord injury(SCI).[Methods]A retrospective research was performed on 80 patients received surgical treatment for LCSFD combined with SCI from September 2018 to August 2022.According to doctor-patient discussion,40 patients had operation performed through the anterior approach(AA),while the other 40 patients were through the posterior approach(PA).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups were operated on smoothly,and the AA group proved significantly superior to the PA group in terms of operation time[(95.0±10.4)min us(123.5±13.6)min,P<0.001],the total incision length[(3.5±0.6)cm us(11.2±2.0)cm,P<0.001],intraoperative fluoroscopy times[(3.6±1.2)times vs(6.5±1.5)times,P<0.001],intraoperative blood loss[(96.2±14.6)ml us(254.5±30.5)ml,P<0.001],postoperative drainage[(40.2±8.7)ml us(66.0±12.4)ml,P<0.001],hospital stay[(8.2±2.6)days us(12.5±3.8)days,P<0.001]and the time to resume full weight-bearing activity[(74.2±12.0)days us(83.5±14.6)days,P=0.003].The VAS,NDI,JOA scores and ASIA grades in both groups were significantly improved as time went on(P<0.05).The AA group was significantly better than the PA group in terms of VAS score[(2.0+0.4)us(2.4±0.5),P<0.001],NDI[(26.1±5.3)us(29.0±5.6),P=0.020]and the JOA score[(13.6±2.3)us(12.3±2.1),P=0.010]3 months postoperatively,as well as the VAS score at the last follow-up[(1.5±0.3)us(1.7±0.4),P=0.013].In term of imaging,the local kyphotic angle,injured vertebral slippage,relative height of intervertebral space and vertebral canal area of affected segment were significantly improved in both groups after surgery compared with those preoperatively(P<0.05).The AA group was significantly better than the PA group in terms of local kyphotic angle[(4.2±0.8)vs(5.0±1.6)°,P=0.006],the injured vertebral slippa

关 键 词：下颈椎骨折脱位 脊髓损伤 复位 固定融合 前路 后路 

分 类 号：R683.2[医药卫生—骨科学]