颈椎骨折前后减压治疗高位截瘫疗效观察

目的 探讨高能量损伤致颈椎骨折脱位伴小关节突绞锁的患者，实施一期前后联合入路手术，对该方法的可行性及其疗效进行评价并讨论。方法 手术分两步进行：（1）局麻＋颈丛麻醉，先行后路小关节突部分切除，撬拨复位，棘突间双股“8”字钢丝内固定，髂骨植骨融合术。（2）前路椎间减压自体髂骨块移植Orion带锁钢板固定。结果 术后经3～36个月随访，X线片示16例患者颈椎骨折脱位全部复位，恢复了颈椎椎体的正常序列及生理弧度，6个月后植骨全部融合，无钢丝、钛板、螺钉断裂及松动。结论 严重下颈椎骨折脱位的一期前后联合手术是可行的，具有容易复位，稳定性好，植骨易融合，便于术后护理和功能康复的优点。

Curative Effect around Cervical Vertebra Fracture Decompression in the Treatment of Top Digit Paraplegia

Objective To discuss the feasibility of anterior-posterior approach for patients with cervical vertebra fracture-dislocation and articular process interlocking. Methods The surgery was divided into two steps to carry on： （1）local anesthesia ＋ cervical plexus anesthesia, small zygapophyseal processed partial excision, poking reduction, interspious double strand “8” steelwire fixed, transplanted iliac bone fusion. （2）Anterior intervertebral decompression and autograft transplantation from iliac bone with “Orion” locking steel plate fixedly. Results After 3 to 36 month follow-up, X-ray demonstrated 16 patients of cervical fracture and dislocation were recovery and restored the normal cervical vertebrae sequence and physiological curvature. After 6 months the bones were fused completely, no the steel wire, the titanium board, and the screw were broken and loosened. Conclusion The severe infernal cervical vertebra fracture-dislocation and the implementation of anterior-posterior approach surgery are feasible, easily reset, stable, easy-integred, and facilitate postoperative care and rehabilitation.