前后路一期手术治疗复杂下颈椎损伤  

One-stage operation by anterior and posterior approaches in treatment of intricate lower cervical injury

作　　者：尹庆水[1] 刘景发[1] 夏虹[1] 吴增晖[1] 章凯[1] 昌耘冰[1] 权日[1] 张余[1] 

机构地区：[1]广州军区广州总医院骨科,广州市510010

出　　处：《中华创伤骨科杂志》2004年第3期281-283,共3页Chinese Journal of Orthopaedic Trauma

基　　金：广东省重点攻关项目(99B06703G)

摘　　要：目的探讨前后路一期减压内固定手术治疗复杂下颈椎损伤的临床效果和价值。方法22例复杂下颈椎损伤在全麻下行前后路一期手术,先后路减压复位侧块钢板内固定,再前路减压植骨;或者先后路单开门减压,再前路椎体次全切除,植骨前路钢板内固定。结果平均随访18个月,8例脱位者达完全复位,受压脊髓得到有效减压。内置物无松动,无断裂,植骨后4个月均骨性融合,无血管、神经、食道、气管损伤并发症。脊髓功能均有不同程度恢复,发生2例消化道应激性溃疡。结论只要掌握好适应证,前后路一期手术治疗复杂下颈椎损伤是一积极有效的方法。Objective To investigate the value of one stage operation by combined anterior with posterior approaches in the treatment of intricate lower cervical injury. Methods 22 cases of intricate lower cervical injury were operated on under general anesthesia by one stage operation in which the decompression, reduction, and internal fixation with the Axis lateral cervical mass plate were conducted at first through posterior approach and then decompression with autologous iliac graft was done through anterior approach, or decompression by the expansive open door laminoplasty was performed at first through posterior approach and then decompression by resecting the most part of vertebrate body, autologous iliac grafting and internal fixation with locking plate were performed through anterior approach. Results All cases were followed up for 18 months on average. 8 cases got completely reduction. All the compressed spinal cords were decompressed. No injury to the arteries or nerves was found. There were no loosening of the plate and screws. The autologous iliac grafts got fused in four months. The function of spinal cord in all the patents improved by different degrees of the ASIA evaluation. Complication of upper digestive tract ulcer was founded in 2 cases. Conclusion One stage operation by anterior and posterior approach is advisable for the treatment of intricate lower cervical injury.

关 键 词：下颈椎损伤 内固定 手术入路 脊髓功能 适应证 

分 类 号：R687.3[医药卫生—骨科学]