基层医院后前联合入路加用生物膜治疗创伤性下颈椎骨折脱位的临床研究

目的:探讨在西部地区县级基层医院开展后前联合入路手术方法加用生物膜治疗创伤性下颈椎骨折脱位的疗效。探索适合基层医院治疗颈椎复合性损伤的工作模式,更好地为基层人民服务。方法:通过选择本院下颈椎骨折脱位、小关节交锁合并不同程度的脊髓损伤患者32例,采用先从颈椎后路切开复位;再从颈椎前路切开,切除后纵韧带,彻底解除对脊髓的压迫,安放生物膜保护脊髓,取相同大小和形状的自体髂骨块植入间隙内;安放内固定物。然后比较手术前后患者的ASIA运动功能指数评分和JOA评分、Frankel分级。结果:32例患者术后均恢复了颈椎椎体的正常序列及生理弧度。随访期间内固定位置良好,无植骨块脱出或钢板、螺钉松动、断裂等并发症。术后JOA评分和ASIA运动功能指数评分有统计学意义(P<0.05);脊髓神经功能Frankel分级获得不同程度的提高。结论:基层医院后前联合入路加用生物膜治疗创伤性下颈椎骨折脱位效果满意。

The Clinical Research of the Treatment on Combined Posterior and Anterior Approach with Biomembrane for Lower Cervical Spine Fracture and Dislocation in the Primary Hospital

Objective:Investigate the effect on combined posterior and anterior approach with biomembrane for lower cervical spine fracture and dislocation in the west primary hospital.Explore the best mode for the treatment on combined cervical spine injury in the primary hospital.Methods:The clinical data of 32 cases of lower cervical spine fracture and dislocation and small joint locking combined with spinal cord injury were analyzed.Completely removing the spinal cord compression with combined posterior and anterior approach,resection of the posterior longitudinal ligament.Placing biomembrane to protect the spinal cord.Taking the same size and shape autologous iliac and implanting the gap,then placing the internal fixation.Comparing the ASIA motor function index score and JOA score and frankel grade before and after surgery.Results:All the patients were returned to the normal cervical sequence and physiological curvature.There was no complication related to internal fixation breakage,loosening or bone displacement during follow-up.There was statistically significant on the ASIA motor function index score and JOA score(P<0.05) after surgery.Frankel grade improved to varying degrees.Conclusion:Treatment satisfaction on combined posterior and anterior approach with biomembrane for lower cervical spine fracture and dislocation in the primary hospital.