一期前路偏心置钉撑开复位融合术治疗下颈椎小关节脱位21例  

Treatment of 21 cases of lower cervical facet dislocation with one-stage anterior eccentric placement nail support,reset fusion surgery

作　　者：吴岳 江东育 崔跃 郑剑卿 郭淳亮 张钦 丁涛 WU Yue;JIANG Dongyu;CUI Yue;ZHENG Jianqing;GUO Chunliang;ZHANG Qin;DING Tao(Department of Orthopedics,Xuzhou First People s Hospital,Xuzhou 221000,Jiangsu,China;Department of Orthopedics,Nanjing Medical University Affiliated Wuxi People s Hospital,Wuxi 214000,Jiangsu,China)

机构地区：[1]徐州市第一人民医院骨科,江苏徐州221000 [2]南京医科大学附属无锡人民医院骨科,江苏无锡214000

出　　处：《中南医学科学杂志》2025年第1期129-132,173,共5页Medical Science Journal of Central South China

基　　金：无锡市卫生健康委科研项目(M202122)。

摘　　要：目的探讨一期前路偏心置钉撑开复位融合术治疗下颈椎小关节脱位的临床疗效。方法将本院21例下颈椎小关节脱位(单侧13例、双侧8例)患者采用标准Smith-Robinson入路,上下Caspar钉互成一定角度偏心放置,撑开椎间隙后完成椎间盘减压,使用椎间撑开器维持撑开状态,同时使用Caspar钉作为“操纵杆”,提供屈伸与侧方旋转的力,以复位脱位小关节,复位后完成椎间融合。比较手术前后疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分。记录患者手术时间、术中出血量、住院时间、JOA改善率、美国脊髓损伤协会(ASIA)分级及术后融合情况。结果一期前路偏心置钉撑开复位融合术复位成功18例(85.71%),包括单侧复位成功12例及双侧复位成功6例。术后6个月患者VAS评分低于术前,JOA评分高于术前(P<0.01);手术时间(73.89±18.60)min,术中出血量(75.00±13.44)mL,住院时间(6.76±1.87)天,JOA改善率(42.59±18.91)%;在术前出现脊髓损伤的13例患者中,8例(61.54%)患者ASIA分级改善至少1级,其余患者分级无降低。术后复查无融合器移位,无内固定物松动、断裂,融合可靠。结论一期前路偏心置钉撑开复位融合术治疗下颈椎小关节脱位具有复位简单、成功率高、手术创伤小等优点,可作为治疗下颈椎小关节脱位的一种选择,尤其单侧脱位者。Aim To explore the clinical efficacy of lower cervical facet dislocation by treatment of one-stage anterior eccentric nail support,reset fusion surgery.Methods Twenty one patients with lower cervical facet joint dislocation(13 cases on one side and 8 cases on both sides)in our hospital were treated by using the standard Smith-Robinson approach.The upper and lower Caspar screws were placed eccentrically at a certain angle to each other,and the intervertebral disc decompression was completed after widening the intervertebral space.The intervertebral disc was maintained in the expanded state by using an intervertebral disc stretcher,and Caspar screws were used as a“control rod”to provide flexion,extension,and lateral rotation forces to reposition the dislocated facet joint.After reduction,intervertebral fusion was completed.The visual analogue scale(VAS)and Japanese orthopedic association(JOA)score before and after surgery were compared.The patients surgical time,intraoperative blood loss,length of hospital stay,JOA improvement rate,American spinal injury association(ASIA)grading,and postoperative fusion status were recorded.Results 18 cases(85.71%)were successfully reset by one-stage anterior eccentric nail support,reset fusion surgery,of which 12 cases were successful unilateral reset and 6 cases were successful bilateral reset.6 months after surgery,the patient s VAS score was significantly lower,and the JOA score was higher than that before surgery(P<0.01).18 cases had a surgical time of(73.89±18.60)minutes,intraoperative blood loss of(75.00±13.44)mL,and hospital stay of(6.76±1.87)days.The improvement rate of JOA was(42.59±18.91)%.Among the 13 patients who experienced spinal cord injury before surgery,8 patients(61.54%)showed an improvement of at least 1 grade in ASIA grading,while the rest of the patients showed no decrease in grading.Postoperative follow-up showed no displacement of the fusion device,no looseness or breakage of the internal fixation device,and reliable fusion.Conclusion The treatment o

关 键 词：下颈椎小关节脱位 一期前路 偏心置钉撑开 复位融合 临床疗效 

分 类 号：R684.7[医药卫生—骨科学]