前路“三维旋转复位”治疗下颈椎骨折脱位

目的探讨下颈椎脱位前路手术复位的安全性和有效性。方法2004～2007年,34例下颈椎不稳定骨折脱位患者,行前路减压、复位及植骨钛板固定的手术。单侧关节突交锁13例,双侧21例。＂三维旋转复位＂法：上椎体冠状面旋转,复位侧的椎小关节分离;椎体间撑开时使上椎体矢状面前曲至上下关节突分离到＂尖对尖＂的位置;上位椎体水平面旋转向后上关节突绕过下关节突,完成复位。双侧脱位以相对方法复位。结果32例（94.1%）满意复位,2例需要后路手术。随访时间平均38.4个月,均牢固骨性融合。14例不完全性损伤者脊髓功能均获不同程度改善,ASIA残损分级平均提高1～2级;12例脊髓完全性损伤者临床症状,如疼痛、麻木等得到缓解,其中4例ASIA残损分级平均提高1～2级;其余脊髓功能无恢复,ASIA残损分级无变化。结论＂三维旋转复位＂可以减少复位时脊髓实际牵拉距离,提高复位的安全性;急诊前路手术可以获得满意的复位和即刻稳定性的重建。

Anterior "three-dimensional rotation reduction" for lower cervical fracture and dislocation

Objective To investigate the safety and effectiveness of anterior surgery reduction for lower cervical fracture and dislocation with locked-facet. Methods A retrospective analysis of 34 patients with lower cervical unstable dislocations/subluxations fracture from 2004 to 2007. Unilateral facet dislocation were 13 cases, and facet dislocation were 21 cases. All patients had anterior surgical reduction, decompression, fusion and stabilization. "Three-dimensional rotation reduction" method: on the side of reduction, position of superior articular process was offset to the side of inferior articular process slightly by revolving the superior vertebrae. A bending movement to the dislocated vertebral body was applied when distraction. Before inferior and superior articular process were distracted to the "tip to tip" site, through revolved, superior articular process was bypassed the lateral site of the top of inferior articular process, then reduction was completed. The contralateral dislocation could be reduced in the same method. Results Reducion was reached in 32 cases (94.1%), the other 2 cases required posterior surgery. The mean follow-up period was 38.4 months (ranged from 12 to 36 months). The nerve function was improved by 1-2 grade in 16 cases of incomplete spinal cord injuries, clinical symptoms such as pain, numbness and so on, had been alleviated in 12 cases of complete spinal cord injury.The nerve function was improved by 1-2 grade in 4 cases, and the others had no neurological recovery.Conclusion The "three-dimensional rotation reduction" can decrease the actual traction distance of the spinal cord when reduction, and improve the safety of reduction; satisfied reduction and immediate stability can be obtained by the emergency anterior surgery.