规范程序化康复处理在内固定术治疗上位颈椎疾患术后的应用

目的探讨术后康复处理对上位颈椎疾患手术效果的作用,以了解内固定术治疗上位颈椎疾患术后的康复处理方法。方法应用内固定术治疗上位颈椎疾患20例,其中陈旧性齿突骨折11例,新鲜齿突骨折5例,寰枢椎脱位伴颅底凹陷4例。手术方法经后路17例:Apofix寰枢复位内固定植骨融合术12例,寰椎后弓切除、枕骨大孔减压、枕颈CD或CCD内固定及枕颈植骨融合术5例。经前路3例,行齿突螺钉内固定术。术后依照作者所制定原则进行综合的康复处理,康复过程中强调头颈部中立位的牢靠外固定,以及循序渐进的肢体功能康复训练。术前JOA颈髓症评分5～17,平均13.2。结果1例陈旧性齿突骨折伴寰枢椎脱位患者因术后2d不配合,擅自放松颈围、垫高枕,致再发寰椎旋转移位,出现脊髓压迫症状而再次手术,其余均未出现并发症。全部病例随访6～24个月,平均13.7个月。JOA颈髓症评分10.5～17.0,平均16.3。影像学显示植骨区均已骨性融合。结论规范程序化的术后康复处理是内固定术治疗上位颈椎疾患取得良好疗效的重要保证。

Postoperative management and rehabilitation of internal fixation for upper cervical spinal diseases- review of 20 cases

Aim To explore the effect of postoperative rehabilitation on upper cervical spinal diseases .Methods Internal fixation were conducted among 20 inpatients with upper cervical spinal diseases, including 11 old fractures of condyle, 5 acute fractures of condyle and 4 atlantoaxial dislocations accompanied with basilar impression, were treated with internal fixation.17 cases among 20 inpatients were treated with posterior approach and the others with anterior approach. Comprehensive rehabilitation was applied to 20 inpatients after operation. The rehabilitation laid stress on firm external fixation of the neck, and gradual rehabilitation of the limbs and trunk. The JOA scores of the patients preoperatively were10.5-17.0, averaged 13.2. Results 19 cases had no complication, except one case with old fractures of condyle, who was re operated on account of the relapse of atlantoaxial dislocation caused by loosening the neck collar and using high pillow himself 2d post operation. The JOA scores of 20 cases were 10.5-17 postoperatively, averaged 16.3 during a mean follow up of 6-24 months, averaged 13.7 month. And the radiology showed all the bone grafting area had got osseous fusion.Conclusion Standardized postoperative rehabilitation is the key to get a good effect on the upper cervical spinal diseases treated with internal fixation.