严重下颈椎骨折脱位的外科处理(附21例报告)

目的探讨严重下颈椎骨折、脱位合理的外科治疗策略,提出前路复位,如成功则行前路植骨内固定术；如前路复位失败,则后路复位固定,再行前路植骨融合的处理策略,并评价上述两种方法的治疗价值。方法21例严重下颈椎骨折脱位中,前路良好复位,行植骨内固定15例；前路不能良好复位,行后路复位,继而前路植骨内固定6例。手术前、后的神经功能采用Frankel法评估。结果下颈椎骨折脱位全部获得90%以上复位,术后3．5个月椎间植骨全部融合,椎间高度和生理曲度维持良好,无钢板、螺钉松动断裂并发症。16例脊髓不完全损伤者,神经功能获1～2级改善。结论严重下颈椎骨折脱位治疗过程中复位、减压、重建生理弧度和恢复稳定均十分重要。复位是治疗的关键。选择合理的治疗策略,严重下颈椎骨折脱位可获得满意的复位及稳定,有利于神经功能恢复。

Surgical Strategy for Severe Lower Cervical Fracture and Dislocation with a Report of 21 Patients

Objective To discuss the surgical strategy for severe lower cervical fracture and dislocation including the anterior reduction and internal fixation,and anterior and posterior reduction combined with anterior and posterior internal fixation for the stabilization of the severe lower cervical fracture and dislocation.Methods Among 21 patients,the excellent reduction was achieved in 15 patients with anterior locking plate systems while the reduction was unsatisfactory in 6 patients and then the anterior release,the posterior reduction and the anterior and posterior plate implantation were performed for theses patients.The stability and fusion of the injured segments were observed on the X-ray films.The function of the spinal cord was evaluated with Frankel classification.Results The intervertebral height and cervical curvature were restored and maintained satisfactorily.There were no operation complications.The nerve function was improved by 1 grade or 2 in 16 patients with the incomplete injury of the spinal cord postoperatively according to the Frankel classifica- tion.Conclusion The reduction,the decompression,the reconstruction of the physiological curvature and the restoration of the stability are all very important for the treatment of the severe cervical fracture and dislocation.The reduction is the key for the treatment.The reasonable strategy can benefit the early recovery of spinal cord.