前后路联合手术治疗颈椎骨折脱位并脊髓损伤

[目的]探讨颈椎骨折脱位并颈脊髓损伤的手术治疗。[方法]对2005.03~2006.12收治的9例颈椎骨折脱位并颈脊髓损伤病人采取一期前后路联合手术。后路行单开门椎管扩大成型减压/椎板切除减压,前路行椎间盘切除/椎体切除、椎间植骨、钢板内固定。[结果]8例骨折脱位均获得完全复位,1例反屈畸形得到纠正。前路钢板及螺钉未见松动、断裂、移位,本组术中无神经、血管、气管及食管损伤,术后未出现与呼吸道相关的并发症,未出现与手术固定技术相关的并发症。本组9例全部获得随访,平均随访18月。椎间植骨3月后均获得骨性愈合。术前脊髓功能按Frankel分级B级5例,C级3例,D级1例。术后脊髓功能均有不同程度恢复。2例由B级恢复到C级,2例由B级恢复到D级,1例由B级恢复到E级,2例由C级恢复到D级,1例由C级恢复到E级,1例由D级恢复到E级。[结论]对于颈椎骨折脱位并颈脊髓损伤,脊髓前后方均受到压迫时,一期前后路联合手术能达到减压充分、稳定脊柱、为脊髓功能恢复创造有利条件。

TREATMENT OF CERVICAL SPINE FRACTURE AND SPINE CORD INJURY WITH COMBINED ANTERIOR-POSTERIOR PROCEDURE

[Objective] To explore the surgical technique for cervical fracture or dislocation with spinal cord injury. [Methods] 9 cases of cervical spine fracture or dislocation with spinal cord injury were given operation through one stage combined anterior-posterior procedure. (Firstly anterior procedure and then posterior procedure) . Posterior operation included expansive open-door laminoplasty or laminectomy for decompression. Then they were given excision of intervertebral disk or vertebral body and bone grafting between vertebral bodies, and anterior fixation with plate through anterior procedure. [Results] All case were followed up for 18 months on average. 8 case of cervical fracture dislocation gained replacement. 1 case of recura- tion deformity got rectification. The implanted bone had synostosis in threee months. According to Frankel system, the spinal cord function was Frankel Grade B in 5 cases, C in 3 case and D in1 case before operation. The function of spinal cord in all cases improved by different grades after operation. 2 cases raised from B to C, 2 cases from B to D, 1 case from B to E, 2 cases from C to D, 1 case from C to E, 1 case from D to E. There were no loosing or migration of a screw or plate, or failure of hardware. No injury to the nerves or vascellum or airtube or esophaged was seen. There were no episodes of respiratory obstruction in present study. No complications related to the technique of fixation was found. [Conclusion] For patients who has cervical fracture dislocation with spinal cord injury, one stage combined anterior-posterior procedure is essential, safe and effective methord for decompression of spinal cord and immedialy stability of spine and optimizes the environment for maximum spinal cord function recover when radiographs demonstrate the cervical spinal cord is compressed from both anterior and posterior directions.