Ⅰ期前后路手术治疗下颈椎骨折脱位

目的 评价Ⅰ期前后路手术治疗下颈椎骨折脱位伴关节突绞锁的可行性和近期临床效果.方法 对27例下颈椎骨折脱位伴关节突绞锁的患者,Ⅰ期行后路复位和前路减压植骨内固定术,定期X线摄片观察损伤节段的稳定性和融合率,观察有无并发症发生,以ASIA分级判定脊髓功能的恢复情况.结果 随访6～32个月(平均21.5个月),27例患者均获得了完全复位,损伤节段稳定,颈椎高度和生理曲度维持良好,融合率为100%,内固定位置良好,无植骨块脱出或钢板、螺钉松动、断裂等并发症,脊髓功能平均提高1.4级,无一例患者出现神经症状加重.结论 Ⅰ期前后路手术治疗下颈椎骨折脱位伴关节突绞锁可获得满意的复位、彻底的减压和即刻稳定性的重建,有利于脊髓功能的恢复,近期临床疗效满意.

One-stage operation in combination with anterior and posterior approach to treat the fracture and dislocation of the lower cervical spine

Objective To evaluate the clinical effectiveness and feasibility of one-stage operation in combination with anterior and posterior approach to treat the fracture and dislocation complicated with articular process interlocking of the low cervical spine.Methods Twenty-seven patients with fracture and dislocation complicated with articular process interlocking of the low cervical spine were treated by one-stage operation in combination with anterior and posterior approach.The stability and fusion of the injured segments were observed on the X-ray film,and the spinal function was evaluated with ASIA classification.Results Twenty-seven patients were followed up from 6 to 32 months(mean 21.5 months).All cases got completely reduction.The injured segments were stable,the intervertebral height and lordosis maintained satisfied and the rate of fusion was 100%.There was no complication of strut graft extrusion and plate or screws or loosening or broken.The function of spinal cord was improved by 1.4 grade according to ASIA classification.No patients had deteriorative symptoms and signs.Conclusion The complete reduction and thorough decompression and immediately stability can be achieved in the treatment of the fracture and dislocation of severe low cervical spine through the anterior and posterior approaches.This technique is benefit to patients for functional recovery of spinal cord and the short-term effectiveness was satisfactory.