前路钢板结合钛网植骨在不稳定型下颈椎骨折治疗中的应用

目的观察钛网结合钛钢板内固定治疗不稳定型下颈椎骨折的临床效果。方法对36例不稳定型下颈椎骨折患者应用前路减压、钛网植骨加前路钢板固定,并对其疗效进行评价。结果所有患者随访4~28个月,平均随访17个月,按Frankel评分标准进行术前术后神经功能评定;围手术期无明显并发症,植骨均在术后12周达到临床愈合,颈椎生理曲度保持良好,无椎间盘高度的丢失,钛网无下沉、移位,钢板及螺钉无松动,无神经、血管并发症。术后3.5个月开始出现融合迹象,术后1年骨融合良好。结论不稳定型下颈椎骨折应用前路颈椎钢板固定技术结合钛网植骨治疗,颈椎生理曲度得到恢复,术后颈椎即时稳定性好,并能维持有效的椎间高度,植骨易于融合。通过自体椎体开槽减压取骨或加异体骨植骨避免了髂骨取骨所带来的损伤及手术时间的延长,且住院时间短,有利于患者的早期下床活动和功能恢复。手术病例及方法的选择应根据患者是否有致压因素及颈椎稳定性等情况综合考虑。

Application of anterior plate with titanium mesh and bone graft in the treatment of unstable lower cervical spine fractures

Objective To observe the clinical effect of anterior plate with titanium mesh and bone graft in the treatment of unstable lower cervical spine fractures. Methods Thirty-six cases of unstable lower cervical spine fractures were treated by anterior decompression,anterior plate with titanium mesh and bone graft. Then to evaluate the therapeutic effect. ResultsAll the cases were followed up for 4-28 months (mean 17 months). The preoperative and postoperative neurological functions were evaluated according to Frankel grading criterion. There were no significant complications during perioperative period. Clinical healing was obtained 12 weeks after operation. Cervical curvature and intervertebral height were restored normally. There were no mesh sinking or shifting and no plate or screw loose. No nerve or blood vessel complication occurred. The fusion began 3.5 months after operation, and a good fusion was observed one year after operation. ConclusionBy the application of anterior plate with titanium mesh and bone graft in the treatment of unstable lower cervical spine fractures, the cervical curvature and stability can be restored, the intervertebral height would be maintained and the implanted bone can get fusion easily. The injury and long operation duration caused by auto-ilium graft can be avoided with shorter duration of hospital stay and without complication of donor bone site. It is good for early ambulation and functional recovery of the patients. The choice of the operated case and operative method should be considered according to the factors such as whether there is spinal cord compression and the stability of cervical spine and so on.