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。

Surgical treatment by anterior approach for lower cervical fracture and dislocation combined spinal cord injury

Objective： To discuss the reduction rate and clinical outcome of anterior surgical treatment for lower cervical fractures and dislocations combined spinal cord injury. Methods： From Jan. 2006 to Jan. 2011, 196 patients of lower cervical fractures and dislocations combined spinal cord injury were treated in our hospital. 168 of them, including 123 male and 45 female aging from 18 to 71 years （mean 38.7 years）, were followed up. All cases were treated with skull traction before operation, then underwent anterior further reduction with Caspar distractor and discectomy under general anaesthesia. If the reduction failed, subtotal resection of the dislocated vertebra should performed firstly followed by reduction again. If reduction failed again, one-stage posterior solution was performed at first then anterior surgery was carried out. Results： In this group, 148 patients got reduction by anterior approach, other 20 patients got reduction by anterior-posterior-anterior approaches. Among them, 151 cases got complete reduction, 17 obtained more than 90% re- duction. 141 patients were followed up, 27 patients were lost, the average follow-up time was 30.7 months. All patients got bony fusion 6 months after operation, the normal intervertebral height and lordosis maintained, no plates and screws complications were noted. 153 cases of neurological defect improved postopera- tively. Conclusion： For lower cervical fractures and dislocations with spinal cord injury, anterior approach surgery not only can obtain a satisfactory reduction rate and immediate stability, but also can prevent sec- ondary spinal cord injury and improve the spinal cord function.