陈旧性颈椎小关节脱位的稳定性重建

１９８８年１２月～１９９３年１２月治疗１２例陈旧性颈椎小关节脱位，其中男８例，女４例，平均年龄３７．８岁，受伤至入院时间平均３．７个月。脱位节段为Ｃ３，４１例，Ｃ４，５４例，Ｃ５，６４例，Ｃ６，７３例。单侧关节脱位７例，双侧关节脱位５例。入院时检查有脊髓和神经根症状５例，仅有神经根症状５例，无脊髓和神经根症状２例。治疗方法是在关节突切除、植骨融合的基础上，分别在椎板或棘突上用钢丝固定４例，用Ｌｕｑｕｅ棒固定１例，前路松解加后路椎板成形减压１例，不作内固定而在术后持续颅骨牵引６例。平均随访３年２个月，比较４种治疗方法的效果，发现术后采用持续颅骨牵引的复位效果较好。其原因可能是手术切除了交锁的关节突后，持续的颅骨牵引可使已瘢痕化的脱位椎骨间连接逐渐松动，趋于恢复到正常的颈椎轴线，并在这个过程中复位的椎骨间发生融合，稳定了脊柱

RECONSTRUCTION OF CERVICAL STABILITY FOLLOWING OLD FACET DISLOCATION OF CERVICAL SPINE/

A total of 12 cases of old facet dislocations of cervical spine treated between december 1988 and 1993 were analyzed in order to evaluate the efficacy of various surgical modalities. In this series, there were 8 males and 4 females, with ages ranged from 16 to 50 years old (averaged 37.8 years old). The duration from injury to admission to our hospital was ranged from 1 to 8 months (averaged 3.7 months). Dislocation levels were as follows: C 3,4 in 1 case, C 4,5 in 4 cases, C 5,6 in 4 cases and C 6,7 in 3 cases. Unilateral facet dislocation was in 7 cases and bilateral facet dislocation in 5 cases. Neurological status on admission was as follows: spinal cord and nerve root lesion in 5 cases, nerve root lesion alone in 5 cases and neurologically intact in 2 cases. Besides all facets receiving facetectomy and iliac bone graft, other four kinds of adjuvant treatments were used, including internal fixation by stainless wires laminae or spinous processes in 4 cases, Luque rod in 1 cases, anterior fibrolysis combined with posterior laminoplasty in 1 cases and sustained skull traction without internal fixation in 6 cases. The reduction efficacy from postoperative sustained skull traction was better and the stainless wires fixation ranked the next. The patients only suffering from the nerve root lesion recovered better, but those who had spinal cord combined with nerve root lesion recovered badly. In conclusion, for the treatment of old facet dislocation, it is necessary to resect the facet and graft with iliac bone.