颅骨牵引复位后经颈前路融合内固定术治疗无神经症状型单节段颈椎间盘撕裂伴关节突绞锁临床观察  

Clinical observation of skull traction reduction combined with ACDF in the treatment of asymptomatic single-segment cervical disc tear with facet joint lock

作　　者：杨帆[1] 钟炯彪 王佩珊 袁野[1] 彭家睿 权庆 YANG Fan;ZHONG Jiongbiao;WANG Peishan;YUAN Ye;PENG Jiarui;QUAN Qing(Department of Orthopedics,Yueyang Hospital Affiliated to Hunan Normal University(Yueyang People's Hospital),Yueyang 414000,China)

机构地区：[1]湖南师范大学附属岳阳医院(岳阳市人民医院)骨科,湖南岳阳414000

出　　处：《山东医药》2025年第3期102-105,共4页Shandong Medical Journal

基　　金：湖南省自然科学基金资助项目(2025JJ70250)。

摘　　要：目的观察颅骨牵引复位后经颈前路融合内固定术(ACDF)治疗无神经症状型单节段颈椎间盘撕裂伴关节突绞锁的临床效果。方法选择无神经症状型单节段颈椎间盘撕裂伴单侧关节突绞锁患者18例,均采用颅骨牵引复位后ACDF进行治疗。记录患者手术时间、术中出血量、切口愈合情况、围手术期并发症等一般情况;患者术后随访至少12个月,末次随访时记录椎间融合情况及关节突绞锁复位情况,比较其术前及术后3 d、3个月、6个月、12个月的C2~7颈椎前凸Cobb角(简称Cobb角)、损伤椎间隙高度、颈椎功能障碍指数(NDI)、JOA评分。结果18例患者均顺利完成手术,术中出血量(101.98±8.68)mL,手术时间(112.85±4.76)min,手术切口均甲级愈合,术中无颈动脉、椎动脉、气管、食管损伤。末次随访的影像学检查结果显示,所有患者关节突绞锁已复位,颈椎序列保持良好,椎间高度及颈椎稳定性正常,达到骨性融合标准。与术前比较,患者术后3 d及术后3、6、12个月Cobb角、损伤椎间隙高度均升高而NDI均降低,患者术后6、12个月JOA评分均升高(P均<0.05)。与术后3 d比较,患者术后3、6、12个月NDI均降低(P均<0.05),术后6、12个月JOA评分均升高(P均<0.05)。结论颅骨牵引复位后ACDF治疗无神经症状型单节段颈椎间盘撕裂伴关节突绞锁安全、有效。Objective To observe the clinical effect of anterior cervical discectomy and fusion(ACDF)after skull traction reduction for the treatment of asymptomatic single-segment cervical disc tear with facet joint lock.Methods Eighteen patients with asymptomatic single-segment cervical disc tear with facet joint lock were treated with ACDF after skull traction reduction.Operation time,intraoperative blood loss,incision healing,and perioperative complications were recorded.The patients were followed up for at least 12 months.The situation of interbody fusion and the reduction status of the facet joint lock were recorded at the last follow-up.The C2-7 cervical lordosis Cobb Angle,injured intervertebral space height,cervical dysfunction index(NDI),and JOA scores were compared before the operation and 3 d,3,6,and 12 months after the operation.Results The operations of 18 patients were successfully completed,intraoperative blood loss was(101.98±8.68)mL,operation time was(112.85±4.76)min,surgical incision were grade A healing,and no carotid artery,vertebral artery,trachea,esophagus injury were found.The imaging examination results of the last follow-up showed that the facet joint lock had been reduced in all patients,the cervical sequence remained good,the intervertebral height and cervical stability were normal,which met the bony fusion criteria.Compared with that before the operation,the Cobb angle and height of injured intervertebral space increased and the Neck Disability Index(NDI)decreased at 3 d after the operation and 3,6,and 12 months after the operation,and the Japanese Orthopaedic Association Scores(JOA)scores increased at 6 and 12 months after operation(all P<0.05).Compared with 3 d after operation,NDI decreased at 3,6,and 12 months after operation,and JOA score increased at 6 and 12 months after operation(all P<0.05).Conclusion ACDF after traction reduction is safe and effective in treatment of asymptomatic single-segment cervical disc tear with facet joint lock.

关 键 词：颅骨牵引 牵引复位 经颈前路融合内固定术 颈椎间盘撕裂 单节段 单侧关节突绞锁 

分 类 号：R681.5[医药卫生—骨科学]