颈前路减压带锁钢板内固定治疗下颈椎损伤（附51例报告）

下颈椎是指C3～7，包括C7～T1的连接部位。颈椎损伤指的是颈椎外伤后颈椎骨折脱位或颈椎问盘突出，常合并脊髓及神经根受压或损伤。自1999年1月～2002年6月应用颈前路减压、植骨及带锁钢板内固定治疗下颈椎损伤54例，取得良好效果。报告如下。     

前路带锁钢板治疗严重颈椎损伤

目的 :评价AO颈椎前路带锁钢板 (cervicalspinelockingplate ,CSLP)在严重颈椎损伤中的应用效果。 方法 :对 10例颈椎骨折脱位伴截瘫或不全截瘫患者行颈椎前路减压、植骨融合 ,并采用CSLP内固定。结果 :经平均 18个月随访 ,全组病例植骨融合良好 ,未发现钢板螺钉松动、断裂等并发症。结论 :CSLP具有高度的内在稳定性 ,操作简单、安全、并发症少 ,内固定材料生物相容性好、无磁性 ,适用于颈椎骨折、脱位的治疗。     

颈椎前路带锁钢板内固定治疗颈椎骨折并四肢瘫痪

目的：分析颈椎前路带锁钢板内固定治疗颈椎骨折并四肢瘫痪的临床治疗效果。方法：对21例颈椎骨折并四肢瘫痪的患者施行颈椎前路减压、植骨及颈椎前路带锁钢板内固定术。术后定期X线片观察损伤节段的稳定性和融合率以及有无内置物并发症，以Frankle分级判定脊髓功能恢复情况。结果：20例获得随访，时让12～32个月。平均19．3个月。20例患者均取得满意疗效，损伤节段稳定，植骨愈合良好，无内置物并发症，脊髓功能平均提高1．75级。结论：颈椎前路带锁钢板内固定治疗颈椎骨折并四肢瘫痪，能使损伤节段获得稳定性，方便护理和功能锻炼，辅以其他措施则能促进脊髓功能的恢复。     

带锁型颈椎前路钢板在不稳定型下颈椎外伤中的应用

带锁型颈椎前路钢板是近几年应用到颈椎外科的一项新技术。自1999年6月～2002年12月收治68例下颈椎外伤，经带锁型颈椎前路钢板内固定的治疗，取得较好效果。总结如下。     

颈椎前路带锁钢板内固定治疗颈椎骨折并四肢瘫痪

目的:分析颈椎前路带锁钢板内固定治疗颈椎骨折并四肢瘫痪的临床治疗效果.方法:对21例颈椎骨折并四肢瘫痪的患者施行颈椎前路减压、植骨及颈椎前路带锁钢板内固定术.术后定期X线片观察损伤节段的稳定性和融合率以及有无内置物并发症,以Frankle分级判定脊髓功能恢复情况.结果:20例获得随访,时间12～32个月.平均19.3个月.20例患者均取得满意疗效,损伤节段稳定,植骨愈合良好,无内置物并发症,脊髓功能平均提高1.75级.结论:颈椎前路带锁钢板内固定治疗颈椎骨折并四肢瘫痪,能使损伤节段获得稳定性,方便护理和功能锻炼,辅以其他措施则能促进脊髓功能的恢复.     

带锁钢板内固定在颈前路术的应用

带锁钢板内固定在颈前路术的应用何海龙１李家顺１贾连顺１颈前路减压植骨融合术已广泛应用于颈椎伤病的治疗，但由于植骨块缺乏支持、不稳，植骨块相关并发症发生率较高〔１〕。采用坚强内固定显然有利于提高融合率，但对内固定的安全性和可靠性要求较高，为此前路钢板一...     

Orion带锁型颈椎前路钢板治疗不稳定型下颈椎外伤

Orion带锁型颈椎前路钢板(anterior cervical locking plat)就是近几年应用到颈椎外科的一项新技术.本文就我院自栽1999年3月～2001年10月间收治的8例下颈椎外伤,经O-rion带锁型颈椎前路钢板内固定的治疗体会总结如下.     

颈椎前路带锁钢板内固定的并发症及预防

上世纪60年代Bohier首先应用颈椎前路钢板治疗颈椎疾病，之后颈椎前路钢板系统有了极大的发展。目前常用的是带锁钢板螺钉系统，该系统为植骨提供了可靠的固定，有利于提高植骨融合率，维持颈椎生理曲度，避免植骨块脱出。我科自1999年12月-2002年5月应用带锁钢板螺钉系统治疗颈椎病86例，发生与手术有关的并发症7例。     

AO纯钛带锁钢板在颈椎前路固定的初步报告

报告了对１５例颈椎疾患患者行颈前路减压植骨融合并采用ＡＯ颈椎纯钛带锁钢板固定。经６个月～８．２个月的随访，所有病例植骨均完全愈合，无一例发生钢板螺钉松动等并发症。颈椎带锁钢板可使固定节段有高度的内在稳定性，并具有操作简便、安全、并发症少、内固定材料生物相容性良好、无磁性等优点，尤其适用于颈椎外伤、肿瘤及退行性变的治疗。     

单节段创伤性下颈椎失稳征的前路植骨带锁钢板手术治疗

目的 观察并总结应用颈前路植骨融合加带锁钢板内固定手术，对24例单节段创伤性下颈椎失稳征的治疗效果。方法 应用颈前路减压植骨融合、带锁钢板内固定对24例单节段创伤性下颈椎失稳征患者进行手术治疗，病程2—52个月，平均10．3个月。平均随访14个月，依据Odom评分标准及截瘫指数ASIA评分进行手术效果评价。结果 应用Orion钢板7例，Zepllir钢板9例，AO钢板2例，Codman钢板6例。24例均获得骨性融合，术后椎间高度维持良好。总有效率91、7％，优良率83.3％。结论 经颈前路减压植骨带锁钢板内固定手术可获得即刻稳定，恢复并有效维持颈椎生理序列及椎间高度，各种颈前路带锁钢板治疗单节段创伤性下颈椎失稳征均可获得较高的移植骨融合率，临床效果满意。     

下颈椎骨折脱位并脊髓损伤的前路手术治疗

目的：探讨颈椎前路手术在治疗下颈椎骨折脱位并脊髓损伤中的复位率及临床疗效。方法：2006年1月～2011年1月,我院前路手术下颈椎骨折脱位伴脊髓损伤196例,168例患者资料完整,并得以随访,男123例,女45例,年龄18。71岁,平均38．7岁。所有患者术前先行小重量颅骨牵引（1．5～4．5kg）,随后在全麻下行颈椎前路手术进一步复位,先行损伤节段椎间盘切除,以Caspar撑开器撑开复位;不能复位者,行脱位椎体次全切除,再次复位;仍不能复位者,则一期行后路松解,再行前路手术。结果：168例中经颈前路手术复位者88．1％（148／168）,其余19．9％（20／168）则通过前路一后路一前路手术获得复位。89．9％（151／168）获得了完全复位,10．1％（17／168）获得了90％以上的复位。平均随访30．7,术后6个月均获得骨性融合,颈椎椎间高度和生理曲度维持良好,无钢板螺钉并发症。术后153例脊髓损伤者神经功能获得改善。结论：下颈椎骨折脱位并脊髓损伤,多可通过前路手术治疗,该入路可使颈椎获得即刻的稳定,防止继发性脊髓损伤,改善脊髓的功能状况。     

前路手术治疗严重下颈椎骨折脱位

目的：探讨前路手术在治疗严重下颈椎骨折脱位中的价值。方法：32例严重下颈椎骨折脱位均在全麻下行颈前路减压、复位、自体髂骨植骨及AO颈椎带锁钢板固定。结果：完全复位17例,复位90%以上15例,平均随访28个月,颈椎椎间高度和生理曲度维持良好,无钢板螺钉并发症,21例脊髓不完全损伤者神经功能获得改善。结论：严惩下颈椎骨折脱位选择前路手术治疗可获得满意的复位和即刻稳定性的重建。     

前路植骨融合带锁钢板内固定治疗颈椎外伤性滑脱

[目的]探讨应用前路植骨融合带锁钢板内固定技术治疗颈椎外伤性滑脱(TSCS)。[方法]24例TSCS，新鲜损伤19例，陈旧性损伤5例。采用颈椎牵引复位后颈前路植骨融合及带锁钢板内固定术进行治疗，术后颈围外固定至融合。[结果]随访10～32个月，平均18个月，24例植骨块与上下椎体融合。无钛板松动移位、断裂。所有患者颈部疼痛和上肢放射痛症状消失或基本缓解。合并颈髓损伤的15例按ASIA分级均有不同程度恢复。[结论]前路植骨融合带锁钢板内固定可重建颈椎即刻稳定性，有效防止继发性脊髓损伤，是治疗1’scs安全可靠的治疗方法。     

前后路一期手术治疗复杂下颈椎损伤

目的 探讨前后路一期减压内固定手术治疗复杂下颈椎损伤的临床效果和价值。方法 22例复杂下颈椎损伤在全麻下行前后路一期手术，先后路减压复位侧块钢板内固定，再前路减压植骨；或者先后路单开门减压，再前路椎体次全切除，植骨前路钢板内固定。结果 平均随访18个月，8例脱位者达完全复位，受压脊髓得到有效减压。内置物无松动，无断裂，植骨后4个月均骨性融合，无血管、神经、食道、气管损伤并发症。脊髓功能均有不同程度恢复，发生2例消化道应激性溃疡。结论 只要掌握好适应证，前后路一期手术治疗复杂下颈椎损伤是-积极有效的方法。     

不稳定型下颈椎损伤的手术治疗(附56例分析)

目的分析手术治疗下颈椎不稳定性损伤的适应证、手术方法及疗效。方法2001年1月～2003年1月,手术治疗下颈椎不稳定性损伤共56例。参照Aebi及White等人的手术适应证,以前路手术为主;对于难复性颈椎脱位或不伴椎间盘损伤者,行后路施术或前后联合入路手术;稳定性评分大于8分的前后柱损伤者,行前后联合入路手术。以Frankel评分系统评价神经功能恢复情况,以损伤节段Cobb角及水平移位来评价复位情况,采用Bohlman的X线片标准判定植骨融合情况。结果Frankel评分术前平均为2.3分,术后3.1分;按Bohlman标准3个月时植骨融合率为80%,6个月时为100%。术前Cobb角平均为8°,术后为1.5°,水平移位由术前的平均3.5mm减小到0.5mm。结论手术治疗下颈椎不稳定性损伤具有改善神经功能、恢复颈椎序列、恢复椎间高度及生理曲度、可早日下地活动等优点,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综合考虑。     

Complications during and after surgery of the lower cervical spine by isolated anterior approach with CSLP implant

Background  The merits of different operative approaches in the management of spinal injury is debated. The aim of this study was to assess, retrospectively, the outcome of treatment of injuries of the lower cervical spine by an anterior approach, in terms of fusion rate and complications. Materials and methods  Between 1995 and 2004, 270 patients with an injury of the lower cervical spine were operated on by an anterior approach in our hospital. There were 67 females and 203 males. Using the Aebi and Nazarian classification, 22% of patients had a type A injury, 23% of patients had a type B injury and 55% of patients had a type C injury. All had an anterior approach with monocortical stabilisation using a cervical spine locking plate [Synthes]. Results  Radiological evidence of fusion was found in all but one patient at 6 months. Complications occurred in a small proportion of the series. Recurrent laryngeal nerve injury was noted in seven patients, an abscess in the wound in one patient, a haematoma requiring re-operation for evacuation in two patients. The cervical locking plate broke in one patient and this patient went on to develop a pseudoarthrosis from failure to fuse. In another patient there was release of the plate osteosynthesis. Conclusions  Treatment of the injured lower cervical spine by an anterior operation and plate fixation was successful in achieving bone fusion in almost every patient and was followed by a complication in only a small proportion of our series. Similar results in other reports indicate that this approach is a safe and effective procedure.     

Anterior decompression and plate fixation in fracture dislocations of the lower cervical spine

Summary Surgical treatment of unstable traumatic injuries of the cervical spine can be carried out by a posterior or anterior approach, with different advantages and disadvantages. Twenty patients were treated with anterior decompression, interbody fusion with autogenous iliac bone graft, and osteosynthesis with a Louis anterior plate. The screws were inserted in the vertebral body without reaching the posterior vertebral wall. There were 18 male and 2 female patients, aged between 18 and 66 years (average 36 years). The osteoarticular lesion was in 8 cases a tear-drop fracture and in 12 a fracture-dislocation. The mechanisms of injury were flexion-compression, flexion-rotation, hyperflexion, and hyperextension. A complete spinal cord lesion was present in 10 cases, central cord syndrome in 5, isolated radiculopathy in 3, and anterior cord syndrome in 1; one patient had normal neurological function. At long-term follow-up fusion of the graft was observed in all cases without evidence of spinal malalignment, breakage of the implant, or aseptic hardware loosening. Neurological deterioration was not observed in any case. In one case, complicated by late infection, healing was uneventful after plate removal, surgical debridement, and antibiotic therapy. A fistula of the hypopharynx due to perforation of the piriform recess appeared following repeated bronchoscopy 12 months after surgery. There were no signs of implant loosening and the lesion was surgically repaired. From a neurological point of view the 10 patients with complete cord lesion remained unchanged; those with incomplete cord lesions improved by 1 or 2 degrees on the Frankel scale; those with isolated radiculopathies recovered fully; and the neurologically intact patient remained unchanged. The present study and the data reported in the literature prove that anterior surgery with plate fixation in cervical spine injuries allows the achievement of complete neural decompression by direct visual examination. On the other hand, posterior surgery can result in incomplete decompression and associated neurological deterioration. Anterior plate instrumentation has proved itself mechanically adequate, even if it is less stable than posterior constructs. The advantages of anterior surgery compared to those of posterior surgery are such that several specific risks are acceptable. Posterior surgery is nevertheless indicated if the lesion cannot be reduced preoperatively under closed conditions.Read at the International Meeting of the Cervical Spine Research Society, Athens, 25th–28th June, 1992     

Aline前路钢板内固定治疗颈椎伤病25例

目的 报道Aline颈椎前路钢板固定系统在颈椎伤病的应用情况。方法 回顾性分析应用Aline颈椎前路钢板治疗颈椎伤病25例的效果。结果 25例全部获得随访，随访时间6个月～2年，植骨均于术后3个月内融合，钢板及螺钉位置良好，无不良并发症发生，神经功能恢复好。结论 Aline钢板固定系统操作简单，术后能提供即刻稳定性，不影响影像效果，但价格较昂贵。