早期后-前路I期手术治疗严重新鲜下颈椎骨折脱位

目的：探讨早期后路颈椎管扩大减压、骨折复位、侧块钉棒固定，联合前路椎体次全切、椎间盘切除以及钛网植骨和钢板内固定技术在严重新鲜下颈椎骨折脱位中的临床疗效和应用价值。方法：纳入2008年1月至2015年1月严重新鲜下颈椎骨折脱位患者156例，患者入院后即安装头环行颅骨牵引，适度复位后早期手术。先取俯卧位行后路手术，植入钉棒系统实现损伤部位的减压、复位和固定。通过部分切除关节突和撬拨、撑开等方法使骨折复位，采用旋棒技术维持并稍加大颈椎在矢状面上的生理前凸。患者改仰卧位，拆除颅骨牵引装置，行前路椎体或椎间盘次全切除，再行椎管减压、椎间植骨及钛板固定。术后定期复查X线片及CT，以观察损伤节段的稳定性和植骨融合率及椎管减压情况，以美国脊髓损伤学会(American Spinal Injury Association，ASIA)分级判定脊髓功能的恢复情况。结果：137例获得随访，失访19例，其中因死亡失访8例。随访时间9.0~35.0(平均13.7)个月。颈椎均获复位，损伤节段稳定，无植骨不融合病例。椎间高度及生理曲度都得到良好重建及维持，无内固定断裂、松动或脱出，未出现血管、食道损伤等并发症。12例末次随访时仍残留颈部疼痛，12例并发颈后伤口感染，经抗炎治疗后I期愈合，13例并发脑脊液漏，对症处理后伤口愈合良好。大多数患者脊髓功能均有不同程度的改善，ASIA评分提高1~2级。结论：对严重新鲜下颈椎骨折脱位，早期采用I期后路侧块钉棒联合前路钢板内固定术可完全恢复颈椎序列，获得良好复位，椎管前后方压迫均能得到彻底解除，损伤节段术后即刻稳定，方便护理和功能锻炼，有利于脊髓功能恢复。

Early and one-stage posterior-anterior surgery for fresh and severe lower cervical spine fracture and dislocation

Objective: To explore the clinical value of early and one-stage posterior laminectomy decompression, fracture reconstruction and lateral mess screw fixation combined with anterior cervical corpectomy or discectomy for the treatment of fresh and severe lower cervical spine fracture and dislocation. Methods: A total of 156 consecutive cases of severe fracture and dislocation of lower cervical spine were reviewed from January 2008 to January 2015. Skull traction was installed when the patients were enrolled in the hospital, so the operation was performed as early as possible. Firstly, the posterior procedure was applied to the patients prone on a frame. A standard posterior laminectomy, fixation and fusion were performed with lateral mass screws and rods. The cervical spine reconstruction was achieved by laminecomy, partially facetectomy, leverage and distraction. The technique of rotating rod was applied to recover the sequence of the cervical and keep or increase the zygopophysis and lordosis of the cervical on the sagittal plane. After the skull traction removed, a standard anterior approach to the cervical spine was initiated as the second stage of the procedure. Anterior cervical corpectomy or discectomy, spinal cord decompression, antograft and cervical spine auto-locking plate fixation were carried out. The stability, the fusion rate of the injured segments and spinal cord decompression were observed on the regular postoperative X-ray film and CT scan. The function of the spinal cord was evaluated by American Spinal Injury Association (ASIA) classification. Results: A total of 137 cases were followed-up, 19 failed to follow-up and 8 of them were due to death. The follow-up time was from 9.0 months to 35.0 months (mean: 13.7 months). All patients got completely reduction of the cervical spine. The injured segments were stable. There was no patient of bone graft no-fusion. The cervical intervertebral height and lordosis were reconstructed and maintained and all grafts were fused at the end of follow-up period. There was no complication related to internal fixation breakage, loosening or displacement. There was also no neurovascular and esophagus complications during the operation. Twelve patients complained neck pain at the final follow-up. There were 12 cases of wound infection and 12 cases of neck inflammatory. They were healed after anti-inflammatory therapy. There were 13 cases of cerebrospinal fluid leakage, and they were healed after the symptomatic treatment. The neuro-function of most patients was improved, and ASIA classification was improved by 1 to 2 grade. Conclusion: Early and one-stage posterior-anterior decompression and reconstruction for the patients with fresh and severe lower cervical spine fracture and dislocation can achieve good reduction and cervical alignment of cervical spine. The injured segments can gain postoperative immediate stability. It also gives a completely decompression, which is benefit to the patients for nursing, functional exercise, and the functional recovery of the spinal cord.