手法复位在治疗下颈椎脱位伴双侧小关节突交锁中的应用

目的评估手法复位在治疗下颈椎脱位伴双侧小关节突交锁中的有效性及安全性。方法 12例创伤引起下颈椎脱位伴双侧关节突交锁患者,先在C臂X线机监视下闭合手法复位,复位成功后维持颅骨牵引,7-12 d再行颈前路减压植骨内固定手术。结果 12例均手法闭合复位成功,术中未出现生命体征的变化及损伤症状加重。1例Frankel A级患者前路手术后因肺部感染,呼吸衰竭,家属放弃治疗,其余11例获随访5-18个月。末次随访时神经功能恢复Frankel评分：A级7例恢复至B级3例、D级1例,3例未恢复;B级2例恢复D级1例、E1例;C级1例、D级1例均恢复至E级。X线显示片颈椎序列正常,植骨融合,无颈椎不稳。结论下颈椎脱位伴双侧小关节突交锁手法复位治疗是安全、有效的。

Closed reduction in the treatment of lower cervical fracture-dislocations with bilateral facet locked

Objective To evaluate the safety and effective of closed reduction in the treatment of lower cervical fracture-dislocations with bilateral facet locked.Methods 12 cases of traumatic lower cervical fracture-dislocations with bilateral facet locked were treated with closed reduction early supervised under X-ray fluoroscopy and then were continued with skull traction.After 7～12 d,they were all performed with anterior operations.Results All cases got successfully closed reduction.No deteriorated sign of life and nerve symptom was observed.1 case of Frankel A got lung infection and respiratory failure,and the family denied further treatment.11 cases were followed up for 5~18 months.According to Frankel system：in 7 cases of grade A,3 were restored to B,1 to D,and 3 got no improvement;in 2 grade B,1 was restored to D,1 to E;1 case of C and 1 D were restored to E.X-ray showed good cervical spine arragement and fusion.No instability was found.Conclusions Closed reduction in the treatment of lower cervical fracture-dislocations with bilateral facet locked is safe and effective.