后路有限固定的前后路联合治疗陈旧性下颈椎交锁脱位

目的：探讨颈椎Ⅰ期前后路联合360°手术治疗难复性小关节交锁的陈旧性下颈椎脱位的临床疗效和应用价值。方法：自2004年3月至2010年8月,18例陈旧性下颈椎脱位患者,经三维CT检查16例有双侧关节突交锁,2例单侧关节突交锁;MRI检查发现,18例患者均有椎间盘损伤,其中2例为椎间盘突出,9例为椎间盘破裂,7例椎体骨折伴椎间盘破裂。所有患者均进行前后路联合360°手术。术后定期复查X线及CT以观察损伤节段的稳定性和融合率,以Frankel分级判定脊髓功能的恢复情况。结果：18例患者均获得随访,时间6～12个月,平均8.6个月。颈椎脱位均完全复位,无植骨不融合。未出现内固定断裂、松动及脱落,无血管、神经、食道损伤等并发症。神经损伤无加重,Frankel分级平均提高1.2级。结论：颈椎Ⅰ期前后路联合360°手术治疗难复性小关节交锁的陈旧性下颈椎脱位,可以完全恢复颈椎序列,解除颈髓压迫,损伤节段术后获得即刻稳定,不易造成脊髓损伤加重,可为脊髓功能恢复创造有利条件。

Anterior-posterior operation with posteriorly limited fixation for the irreducible old dislocation of the inferior cervical vertebra combined with tiny joint interlocking

Objective: To investigate the clinical outcome and application value of single stage circumferential surgery for irreducible old dislocation of the inferior cervical vertebra combined with tiny joint interlocking.Methods: From Mar.2004 to Aug.2010,18 patients with old dislocation of the inferior cervical vertebra,in which 16 showed double joint interlocking and the others 2 showed single by the three dimensional CT scan.MRI showed that all patients had intervertebral disc injury including intervertebral disc rupture (9 cases),intervertebral disc herniation (2 cases) and the fracture of inferior cervical vertebra accompanying with intervertebral disc rupture(7 cases).All patients were treated with anterior-posterior operation with posteriorly limited fixation.Stability and fusion rate of injury segment were observe by X-ray and CT scan;function of spinal cord was assessed by Frankel grade criteria.Results: All patients were followed up from 6 to 12 months with an average of 8.6 months.Dislocation of cervical vertebra got complete reduction and all grafts got fusion.There was no complication of internal fixation breakage,loosening,displacement and there was no injury of blood vessel,nerve,esophagus during the operation.No function of spinal cord got worse after operation and the function improved by 1.2 grades in average in Frankel grade.Conclusion: Single stage circumferential surgery in treating irreducibly old dislocation of inferior cervical vertebra combined with tiny joint interlocking can complete recover the sequence of the cervical vertebra and relieve the compression of spinal cord and can obtain postoperative immediate stability for injury segment and will not aggravate the injury of the spinal cord and may create beneficial condition for functional recovery of the spinal cord.