无脊髓损伤下颈椎脱位的手术治疗

目的 探讨无脊髓损伤下颈椎脱位的手术方法选择及疗效.方法 分析总结2004年1月-2009年6月手术治疗的无脊髓损伤下颈椎脱位患者11例.根据Allen分类均为牵开屈曲型损伤,其中Ⅰ度脱位7例,Ⅱ度脱位1例,Ⅲ度脱位3例.陈旧性脱位8例,新鲜脱位3例,均为单纯颈椎外伤,不合并其他脏器损伤.单纯前路复位内固定椎间植骨融合7例,前后路联合复位内固定植骨融合4例.术后随访观察临床疗效.结果 11例患者手术经过顺利,术前11例Frankel分级E级,术后11例Frankel分级E级.X线片示11例患者均恢复颈椎正常序列和曲度.随访3～31个月未出现脊髓损伤症状及再脱位.术后3.5～5.5个月(平均4.3个月)达植骨融合.结论 合并关节突交锁的下颈椎脱位宜Ⅰ期行前后路联合复位内固定,无关节突交锁者可单纯前路复位椎间植骨融合.复位及内固定植骨融合术是治疗无脊髓损伤型下颈椎脱位的有效方法.

Operative treatment of subaxial cervical dislocation without spinal cord injury

Objective To discuss the selection and clinical efficacy of operative methods for subaxial cervical dislocation without spinal cord injury. Methods A retrospective study was performed on 11 patients with subaxial cervical dislocation without spinal cord injury treated from January 2004 to June 2009. According to Allen' s classification, all patients suffered from retracted flexion injuries, including seven patients with Ⅰ degree dislocation, one with Ⅱ degree dislocation and three with Ⅲ degree dislocation. There were eighth patients with old dislocation and three with fresh dislocation, both of which were simple cervical trauma without other organ injuries. Open reduction, internal fixation and iliac bone graft spinal fusion were performed in seven patients and combined posterior and anterior open reduction,internal fixation and iliac bone graft spinal fusion in four. All the patients were followed up for observation of clinical effect. Results All operations were completed successfully. There were 11 patients at Frankel grade E preoperatively and 11 at grade E postoperatively. X-ray photographs showed that the sequence and curvature of the cervical spine recovered to normal after operation. All patients were followed up for 3-31 months postoperatively, which showed no redislocation or symptoms of spinal cord injury.Conclusion For lower cervical dislocation combined with locked facet, one-stage combined anterior and posterior reduction and internal fixation should be performed. While for those without locked facet, simple anterior reduction and bone graft spinal fusion is needed. Open reduction, internal fixation and bone graft spinal fusion are effective method for treatment of subaxial cervical dislocation without spinal cord injury.