Ⅰ期前后联合手术入路治疗严重下颈椎骨折脱位

目的探讨一期前后联合手术入路治疗严重下颈椎骨折脱位合并脊髓损伤的临床疗效。方法回顾性分析2003年6月～2008年6月一期前后联合手术复位、减压和内固定治疗76例严重下颈椎骨折脱位合并脊髓损伤的患者。对手术时间、术中出血量、术中术后并发症和术后神经功能恢复情况等进行分析。结果76例患者术后随访6～28个月,平均12个月,术后神经功能评价按Frankel分级,均有1～2个级别恢复,术前A级10例,B级24例,C级31例,D级11例;术后A级4例,B级8例,C级27例,D级24例,E级13例。植骨均在6个月获得骨性融合。本组未出现内固定断裂、松动及脱出,无血管、神经、食道损伤等并发症。结论严重下颈椎骨折脱位选择I期前后路联合手术可完全恢复颈椎序列,椎管前后方压迫得到彻底解除,损伤节段术后获得即刻稳定,能够获得较好的脊髓功能恢复和骨性融合。

One stage combined anterior and posterior approach for severe lower cervical fractures and dislocation

Objective To investigate the clinical effects of one stage combined anterior and posterior approach decompression and internal fixation for severe lower cervical fractures and dislocation. Methods The clinical data of 76 cases of lower cervical vertebral fracture and dislocation combined with spinal cord injury were analyzed retrospectively from June 2003 to June 2008. The surgical time, blood loss during operation, complications of the surgery, neurological improvement were analyzed. Results All the patients were followed up for 6-28 months, the averaged period was 12 months. Solid fusion were obtained in all the cases at 6 months postoperative. Preoperative Frankel grade: A 10 cases, B 24 cases, C 31 cases, D 11 cases. Postoperative Frankel grade: A 4 cases, B 8 cases, C 27 cases, D 24 cases, E 13 cases. There was no complications related to internal fixation breakage, loosening or displacement. There was no neurovascular and esophagus complications during the operation. Conclusion One stage combined anterior and posterior decompression and internal fixation for the pateints with severe fracture and dislocation of lower cervical spine could recover the cervical sequence and obtain good reduction. It also gives a completely decompression. The injured segments can gain postoperative immediate stability. This technique is benefit to the patients for the functional recovery of the spinal cord and bony fusion.