摘要
目的:探讨Ⅰ期后-前路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2005年8月至2009年8月采用颈椎前路钢板和后路侧块钉棒或钉板Ⅰ期联合复位内固定技术治疗严重下颈椎骨折脱位合并脊髓损伤48例,其中男28例,女20例;年龄28～62岁,平均39.6岁。神经功能评价按Frankel分级:A级8例,B级16例,C级20例,D级4例。先采用俯卧位,植入侧块螺钉、减压,复位后,植入板或棒,植骨融合后拆除颅骨牵引置仰卧位,行前路椎体复位、减压、植骨及自锁钛板固定。术后定期复查X线片以观察损伤节段的稳定性和融合率,以Frankel分级判定脊髓功能的恢复情况。结果:48例均获随访,时间6～28个月,平均12个月。术后神经功能均有1～2个级别恢复,其中Frankel C级28例,D级14例,E级6例。植骨均在6个月获得骨性融合。一过性喝水呛咳3例,术后3个月恢复。咽喉部异物感2例,术后1个月消失。未出现内固定断裂、松动及脱出,无血管、食道损伤等并发症。结论:下颈椎骨折脱位合并脊髓损伤选择Ⅰ期后-前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,有利于脊髓功能较好的恢复。
Objective：To investigate the clinical effects of one stage posterior anterior decompression and internal fixation for the treatment of the severe fractures and dislocations combined with the spinal cord injuries of the lower cervical spine.Methods：From August 2005 to August 2009,48 patients（male 28 and female 20,aged from 28 to 62 years with a mean of 39.6 years） with severe fractures and dislocations of lower cervical spine were treated by reduction and internal fixation with one stage combined cervical anterior plating and posterior lateral mass screws and rod or plate systems.Frankel grade A was in 8 cases,grade B in 16 cases,grade C in 20 cases,and grade D in 4 cases before operation.Firstly,the posterior approach was carried out.After inserting the mass screws,decompression and reduction were performed,and the rod or plate systems were embedded.After grafting,the skull traction was removed and initiated the anterior reduction,intervertebral decompression,auto graft and cervical spine auto locking plate fixation.The stability and fusion rate of the injured segments were evaluated on the regular postoperative X ray film.The function of the spinal cord was assesed with Frankle classification.Results：All patients were followed up,ranged from 6 to 28 months with an average of 12 months.Solid fusion obtained in the postoperative 6 months.Frankel grade C was in 28 cases,grade D in 14 cases,grade E in 6 cases after operation.There was no complications related to internal fixation breakage,loosening or displacement.There was no vascular and esophagus complications during the operation.Conclusion：One stage combined anterior posterior decompression and internal fixation in treating severe fracture and dislocations of lower cervical spine could restore the cervical curvature,and obtain good reduction and complete decompression,and gain postoperative immediate stability.This technique is benefit to the patients for the functional recovery of the spinal cord.
出处
《中国骨伤》
CAS
2010年第12期938-941,共4页
China Journal of Orthopaedics and Traumatology
关键词
颈椎
骨折
脱位
外科手术
骨折固定术
内
脊髓损伤
Cervical vertebrae
Fractures
Dislocations
Surgical procedures
operative
Fracture fixation
internal
Spinal cord injuries
