全身麻醉下颅骨牵引复位前路手术治疗下颈椎骨折脱位37例临床分析

目的探讨全身麻醉（全麻）下颅骨牵引复位前路手术治疗下颈椎骨折脱位的疗效。方法对2010年9月至2012年9月收治的37例下颈椎骨折脱位患者，在全麻下颅骨牵引复位后行颈前路减压、复位、植骨及带锁钢板固定手术治疗。结果37例患者平均随访18个月，32例完全复位，5例复位90％以上；颈椎椎间高度和生理曲度维持良好，均获得骨性融合，无内植物并发症，28例脊髓不全损伤患者神经功能获改善，3例美国脊髓损伤学会（ASIA）评级B级、2例ASIA评级C级及2例A级患者术后神经功能无恢复，2例E级患者术后神经功能无加重。结论全麻下颅骨牵引复位前路手术治疗下颈椎骨折脱位疗效满意，且安全可行。

Clinical analysis of 37 patients with lower cervical spine fracture and dislocation with the treatment of anterior approach and dosed skull traction reduction under the general anaesthesia

Objective To discuss the clinical effect of surgical treatment for lower cervical spine fracture and dislocation by anterior approach and closed skull traction reduction under the general anaesthesia. Methods Totally 37 patients with lower cervical fractures and dislocations, who were received from September 2010 to september 2012, were operated under the general anaesthesia by anterior decompression, reduction, auto-graft and cervical spine locking plate fixation after closed skull traction reduction. Results Among 37 patients,32 cases got complete reduction after 18-month follow-up averagely ,and the other 5 cases obtained more than 90% reduction. The normal intervertebral height and lordosis were maintained with synostosis, and there were no plates and screws complications. 28 cases with incompletely neurological defect got improved postoperatively, 3 cases were evaluated as Grade B by American Spinal Injury Association（ASIA） ,2 cases as Grade C ,2 cases of Grade A gained no recovery after operation and 2 cases of Grade E remained the neurological function after operation. Conclusion For the patients with lower cervical fractures and dislocations,the treatment of anterior approach and closed skull traction reduction under the general anaesthesia is satisfactory and safe.