前后路联合手术治疗陈旧性颈椎骨折脱位

目的：探讨同期前后路联合手术治疗陈旧性下颈椎骨折脱位的应用价值。方法：15例采取同期前后路联合手术治疗，颅骨牵引下切开复位。手术在全麻下进行，先采用俯卧位，充分松解后方关节突交锁与脊髓后方压迫。然后置平卧位，行前路椎体复位、减压、植骨及安放钢板固定。结果：15例全部获得随访，平均随访时间34个月，脱位均完全复位，平均融合时间3．3个月，无植骨不愈合及内固定断裂、松动、脱出。无术中血管、神经系统损伤，颈椎生理曲度、脱位椎间高度、颈椎的稳定性维持良好。12例脊髓不全损伤神经功能改善。结论：前后路联合手术，可解除后方关节突的交锁及椎管的压迫，经前侧入路复位、植骨与固定，可完全恢复颈椎的序列，使椎管前后方压迫得到彻底解除，植骨块与上下椎体间接触面积增大，融合率较高，安放钢板操作容易，颈椎术后即刻得到稳定，减少了卧床并发症。

Combined anterior and posterior surgical procedure for the treatment of old fracture and dislocation of the lower cervical spine

Objective:To explore into the value of application on surgical treatment of old fracture and dislocation of the lower cervical spine by combined anterior and posterior approach.Methods:Fifteen patients with old fracture and dislocation of the lower cervical spine were involved,all the patients were treated with this technique from July,1997 to June,2002.All the patients were operated under skull traction.First,the posterior approach was carried out,all the patients were operated in general anaesthesia by posterior decompression,unilateral or bilateral articular process crossbite were brisemented.Then the anterior reduction,intervertebral decomperssion,auto-iliac graft and cervical spine locking plate fixation were executed.Results:Fifteen patients were followed-up from 14 months to 6 years and 2 months(34 months in average).All the patients had solid fusion based on flexion and extension radiographs at average of 3.3 months.Fifteen patients got completely reduction,the normal intervertebral height and lordosis were maintained,and there were no complications related to plate and screw loosening,displacement or breakage.There were no neurovascular complications during the operation,and 12 patients with incompletely neurological defect got improved postoperatively.Conclusion:For old fracture-dislocation of the lower cervical spine,an ideal reduction and immediately stability can be obtained by this technique.This method can increase the area of fusion and reduce the rate of nonunion,it gives a completely decompression and a high rate of successful bony fusion.At the same time,it can reduce complications of lying in bed.