颈胸椎连接段骨折脱位的治疗

目的探讨前路手术在颈胸椎连接段骨折脱位的应用价值。方法自1997年以来共收治21例颈胸椎连接段骨折脱位的患者，受伤至手术时间24小时内4例、2～7天9例、8～14天3例、4周以内5例，均为骨折脱位，其中C6、7 7例，C7 9例，T1 5例。均有不同程度脊髓损伤，按Frankel分级，A级3例、B级6例、C级9例、D级3例。手术行前方入路，骨折椎体大部分切除彻底减压，自体髂骨块植骨融合，并使用前路颈椎带锁钢板内固定。结果全组21例，除因合并肺部感染死亡1例外，20例均获随访，随访时间8个月～3年，平均21个月，植骨全部融合，术后脊髓神经功能有不同程度恢复，其中A级2例、C级1例、D级9例、E级8例，脊柱序列正常，无内固定失败。结论前路手术操作简便，并发症少，骨折脱位复位满意，节段稳定性好，是治疗颈胸椎连接段骨折脱位的一种较好方法。

SURGICAL TREATMENT OF FRACTURE-DISLOCATION OF CONNECT OF CERVICAL VERTEBRAE AND THORACIC VERTEBRAE

Objective To discuss the value of anterior operation in fracture dislocation of connect of cervical vertebrae and thoracic vertebrae. Methods From 1997, 21 patients with fracture dislocation of connect of cervical vertebra and thoracic vertebrae were operated on. The interval between injury and operation was within 24 hours in 4 cases, 2 7 days in 9 cases, 8 14 days in 3 cases and within 4 weeks in 5 cases. The locations were C 6?7 in 7 cases, C 7 in 9 cases and T 1 in 5 cases. The nerves function of spinal of all the cases have different degrees of injury. Classification of Frankel were the following: 3 cases of grade A, 6 cases of grade B, 9 cases of grade C, and 3 cases of grade D.The operative procedure included the following: anterior operation of cervical vertebrae; incision of most fracture vertebral body to decompress; transplantation of ilium bone grafting fusion; and internal fixation of anterior cervical vertebrae with locking steel. Results In 21 patients, 1 died of accompanying by pulmonary infection; 20 were followed up 8 months to 3 years with an average of 21 months. All transplanted ilium had fused. The nerve function of spinal cord had recovered in different degrees( 2 cases of grade A, 1 case of grade C, 9 cases of grade D and 8 cases of grade E); the turn of vertebral column was normal. No internal fixation failed. Conclusion Anterior operation is a better way to treat fracture dislocation of connect of cervical vertebrae and thoracic vertebrae with easy operation, less complications, satisfactory reduction of fracture and good stability.