下颈椎骨折脱位手术方式的初步探讨

[目的]探讨下颈椎骨折脱位合理的手术方式及相关处理.[方法]回顾性分析自2006年2月-2008年8月,分别采用颈椎前路、后路、前后联合入路减压、植骨内固定治疗颈椎骨折脱位23例,其中前路手术12例,后路手术7例,前后联合入路4例,观察手术前后神经功能恢复、脱位纠正、椎体高度恢复、植骨融合等情况,评估手术疗效.[结果]术后随访5～32个月,平均18个月,所有病例术后神经症状无加重;7例完全截瘫患者(神经功能Frankel A级)无任何恢复,14例不完全截瘫患者中,5例Frankel B级恢复到Frankel C级,4例 Frankel C级恢复到Frankel D级,3例Frankel D级恢复到Frankel E级,2例 Frankel D级术后仍为Frankel D级;2例Frankel E级术后无加重.Frankel分值平均由术前的1.6增加到术后2.1(P<0.05);所有病例均复位、颈椎椎体高度恢复;椎体间植骨全部融合,平均融合时间为3.5个月;术后X线片上提示钢板位置正常,椎体螺丝钉无折断及松动,无植骨块松动和脱出.[结论]对于下颈椎骨折脱位来说,应当根据不同的伤情采取合理的手术方式.前路手术可以直接处理损伤椎间盘、即刻消除颈椎不稳;后路手术可以直接解除关节绞锁、脱位,但需排除颈椎间盘损伤的存在,以免在复位时加重脊髓损伤;前后联合入路可以同时处理脱位和损伤椎间盘,但手术创伤和风险较大,应有充分的认识和准备.

Primary exploration to reasonable operative approach for fracture and dislocation of lower cervical spine

[Objective]To explore the reasonable operative methods and surgical treatment for fracture and dislocation of lower cervical spine. [Method] Twenty-three eases of fracture and dislocation of lower cervical spine were treated surgically in 3 approaches from Feb. 2006 to Aug. 2008, and analyzed retrospectively. Twelve patients were treated with anterior decompression and fusion,7 with posterior approach and 4 were treated with a combined anterior-posterior approach. The neural function,correction of dislocation, restoration of vertebrae height, fusion result were assessed and compared. [ Result ] After 5-32 months follow-up , neuronal function of all 23 were observed. All cases were not seen worseing, among which 7 panplegia cases with Frankel A didnt recover,14 incomplete paralysis recoveved to different extents;5 cases with Frankel B amounted to Frankel C,4 cases with Frankel C to Frankel D,3 cases with Frankel D to Frankel E,2 cases with Frankel D remained Frankel D,2 cases with Frankel E remained Frankel E. The average Frankel score increased from 3.8 preoperatively to 4.8 postoperatively. Bone fusion was get in all patients. All dislocations were reduced completely. Cervical vertebrae height reached to the normal, intervertebral fusion was fully realized after average 3.5 months healing time. Postoperative X-ray showed plates and screws were in their correct position, no loosening and breakage of both plates and screws was found. [Conclusion] Flexible and reasonable operative approaches should be adopted to treat fracture and dislocation of lower cervical spine. Anterior approach can be used to remove the injuried disc directly and handle instability of cervical spine immediately, and posterior approach can be used to settle dislocation and interlocking of lesser joint,but intervertebral disc injury must be ruled out simultaneously in order to avoid further injury of spinal cord during the reduction process. Combined approach can solve the dislocation and intervertebral disc injury at the same time,however,higher risk and more operative injury should be considered and adequate preparation and arrangement must be made before operation for the safety purpose.