颈椎骨折患者术中应用改良Halo-vest支架对维持颈椎稳定性及预防脊髓再损伤的作用

背景在颈椎骨折的手术过程中由牵引外固定过渡到手术内固定时易造成脊髓再损伤,导致术后患者功能障碍.目的探讨改良Halo-vest支架对维持颈椎术中稳定性的方法,为预防术中脊髓再损伤积累临床治疗经验.设计前后对照研究.单位南华大学第一附属医院脊柱外科.对象2002-01/2004-06南华大学第一附属医院脊柱外科收治的颈椎骨折患者28例,男22例,女7例;年龄7～69岁,平均58岁.方法28例颈椎骨折患者均在不解除改良Halo-vest支架的固定牵引情况下进行手术内固定治疗.按Odom's标准评估疗效.主要结局观察①28例患者手术后脊柱稳定性.②下床活动及骨折愈合时间.③Odom's标准评估结果.结果①应用改良Halo-vest支架后即可行坐和各种搬动,外固定牵引复位后即开始下床活动.②术中身体翻动不受影响.③无因长期卧床而出现并发症及因外固定支架松动造成脊髓再损伤的病例.④骨折愈合时间平均2.1个月.⑤术后颈椎功能评价优19例,良5例,可3例,差1例.结论改良Halo-vest支架用于颈椎骨折手术中可以维持颈椎稳定性,确保脊髓安全,并有助于术后颈椎功能恢复.

Modified Halo-vest fixation for the stability of cervical vertebra and prevention of medullary re-injury during the operations for the patients with cervical vertebral fracture

BACKGROUND: Medullary re-injury is easily to be induced during the operations of cervical vertebral fracture due to the transition from the external fixation by traction to operative internal fixation, which would cause postoperative dysfunction in patients.OBJECTIVE: To probe into the method of modified halo-vest fixation for the maintenance of cervical vertebral stability to prevent the accumulation of clinical therapeutic experiences in medullary re-injury during the operation.DESIGN: A before-after trial.SETTING: Department of Spine Surgery, First Affiliated Hospital of Nanhua University.PARTICIPANTS: Totally 28 patients with cervical vertebral fractures including 22 male and 7 female cases aged from 7 to 69 years old with an average age of 58 years old were admitted by the Department of Spinal Surgery of the First Affiliated Hospital of Nanhua University during January 2002 to June 2004.METHODS: Twenty-eight cases received operative internal fixation without removal of the modified Halo-vest fixation. Effectiveness was evaluated by Odom' s scale.the evaluation by Odom's scale.up and do all kinds of movement immediately, and they started ground acmedullary re-injury case was found due to the loose of external fixation and good, 3 cases of fair and 1 case of poor were in the postoperative cervical vertebral functional evaluation.CONCLUSION: The application of modified Halo-vest fixation in the cervical vertebral fracture operation can maintain the stability of cervical vertebra to assure the safety of the spinal cord, which is also helpful to the postoperative restoration of cervical vertebral function.