下颈椎骨折脱位合并脊髓损伤的手术治疗

目的探讨下颈椎骨折脱位合并脊髓损伤的手术治疗。方法回顾性分析27例下颈椎骨折脱位合并脊髓损伤患者行手术治疗的临床资料,其中颈椎压缩型骨折脱位15例,颈椎爆裂性骨折脱位4例,单侧小关节脱位5例,双侧小关节脱位3例,美国脊髓损伤学会（ASIA）评分：A级5例,B级7例,C级12例,D级3例。13例采用前路手术,8例采用后路手术,6例采用前后联合入路手术。结果术中均无大血管、气管、食道、脊髓意外损伤。术后随访12～36个月,平均18个月。无一例发生钢板、螺钉松动、断裂等并发症。植骨于术后12周均获得骨性融合,无假关节、骨不连发生,90%患者术后获得完全复位,术后颈椎间高度、生理曲度无丢失。完全性脊髓损伤患者术后神经功能均无恢复,但上肢疼痛、麻木有不同程度的缓解。不完全性脊髓患者术后神经功能均有一定恢复,平均ASIA评分提高1～2级。结论根据颈椎损伤的类型采用适合的手术入路手术治疗下颈椎骨折脱位均能达到良好的解剖复位,取得良好的临床疗效。

The Surgical treatment of fracture and dislcation of lower cervical spine combined spinal cord injury

Objective To explore the surgical method and clinical effects for the treatment of fracture and dislocation of lower cervical spine combined spinal cord injury. Methods The clinical data of 27 patients of lower cervical spine fracture and dislocation were retrospectively analyzed. There were 15 cases with vertebral body compressive fracture and dislocation,4 cases with vertebral body bursting fracture and dislocation, 5cases with unilatetal facet dislocation, 3 cases with bilateral facet dislocation. All cases were associated with spinal cord injury. Accoding to American Spinal Injury Association（ASIA） grades,5cases were in A grade,7 cases in B grade, 12 cases in C grade and 3 cases in D grade. All patients had surgical reduction, decompression, stabilization and fusion, in these cases, anterior procedure was performed in 13, posterior procedure in 8, combined anterior and posterior procedure in 6. Results All patients were followed up in 12 to 36 months,the mean followup time was 18 months. There were no great vessels, trachea, esophagus or spinal cord iatrogenic injury. There were no pull-out and breakage of screws or plates. Fusion was achieved in all patients at an average of 12 weeks postoperatively. There were no pseudarthrosis of bone nounion. Of all the patients ,96. 3% were aquired completely reduction and the normal intervertebral height and lordosis were maintained. Patients with complete spinal cord had no neurologic recovery, but they felt relief from upper limb pain or numb. Incomplete spinal cord lesions improved on average 1-2 Frankel grade after surgery. Conclusion Surgical treatment of different types of cervical fracture and dislocation can achive an efficient and safe clinical outcome,while reliable selection of surgical procedure on carfully considering the patient＇s status before operation.