颈前路手术治疗颈椎颈髓损伤

目的：探查前路手术在治疗颈椎、颈髓损伤中的价值。方法：31例颈椎骨折、脱位伴颈髓损伤的病人，均在全麻下行颈前路减压、复位、自体髂骨植骨及ORION钢板内固定。按神经功能Frankel分级标准，于术前、术后3个月、6个月，对所有病例均进行分级评定。结果：28例获访病人中，平均随访时间为13.8个月，骨折、脱位复位均满意，植骨于术后3个月融合，无钢板螺钉松动、断裂等并发症，术后3个月、6个月时Frankel分级好转率分别为50％和82．1％，Frankel分级平均改善0.64级和1．14级。结论：选择前路手术治疗颈椎、颈髓损伤，可获得满意的复位和即刻稳定性的重建；早期手术不仅可明显改善脊髓的功能状况，还可避免因发生并发症而错过手术时机。

Anterior approach in the surgical treatment of cervical fracture and spinal cord injury]

OBJECTIVE: To explore value of the anterior approach in the surgical treatment of cervical fracture and spinal cord injury. METHODS: Thirty-one cases of cervical fracture and spinal cord injury were treated. All the patients were operated on in general anaesthesia by anterior decompression, reduction, auto-iliac graft and ORION cervical plate fixation. All the cases were evaluated according to Frankel criteria of the neural function preoperatively, and 3 months and 6 months after the operation. RESULTS: Twenty-eight cases were followed up for an average of 13.8 months (ranging from 3 to 18 months). All the fractures and dislocations were reduced satisfyingly. All the bone-grafts were fused within 3 months after the operation. There was no plate or screw complication in any of the cases. The Frankel grade improvement rates were 50%, and 82.1% in 28 cases at 3 months and 6 months postoperatively; the average Frankel grade was improved by a 0.64 and 1.14 grade respectively. CONCLUSION: For cervical fracture and spinal cord injury, an ideal reduction and immediate stability can be obtained through the anterior approach. Early surgery can significantly improve the spinal cord function and avoid missing the operation opportunity due to occurring complications.