摘要
背景:下颈椎骨折手术入路选择目前存在争议。目的目的:探讨下颈椎骨折的手术入路选择策略及临床疗效。方法法:选取2012年1月至2015年12月手术治疗的59例下颈椎骨折患者,男38例,女21例;年龄28～76岁,平均45.3岁。AO分型为A3型骨折9例,B2型骨折29例,B3型骨折6例,C型骨折15例。根据美国脊髓损伤协会(ASIA)分级标准,A级5例,B级11例,C级20例,D级14例,E级9例。对于A3型和B3型骨折选择前路手术,B2型多选择后路手术,C型骨折选择前路/前后路联合手术。随访患者神经功能改善情况,影像学评价骨折愈合及植骨融合情况。结果结果:59例患者均获随访,随访时间6～25个月,平均16.3个月。24例选择前路手术,22例选择后路手术,13例选择前后路手术。57例患者均获得骨折/脱位复位,术后6个月复查骨折愈合,植骨融合良好,2例C型骨折行前路手术患者术后1个月内出现内固定失效,二次手术行前后路联合手术。5例ASIA分级A级患者神经功能均无恢复,不完全脊髓损伤患者ASIA分级均提高1～2级。结论结论:下颈椎骨折手术入路的选择应遵循在神经减压基础上,重建张力带与小关节稳定性的原则。对于A3型(单纯椎体骨折)和B3型(前方张力带损伤)骨折应采用前路手术,对于B2型(后方张力带损伤)骨折应首选后路手术,对于C型骨折应采用前路/前后路联合手术。
Background:There are still controversies on the choice of surgical approach for subaxial cervical spine fractures. Objective:To explore the operative approach and clinical outcomes of subaxial cervical spine fractures.Methods:Fifty nine patients with subaxial cervical spine fractures receiving surgery from January 2012to December 2015were recruited including 38males and 21females with a mean age of 45.3years (range,28-76years).According to the AO classification,there Were 9 cases of A3fractures,29of B2fractures,6of B3fractures,and 15of C fractures.According to the American Society of Spinal Cord Injury Association (ASIA)grading criteria,there were 5cases of grade A,11cases of grade B,20cases of grade C,14cases of grade D,and 9cases of grade E.Anterior surgery was selected for A3and B3fractures,posterior surgery was selected for B2fractures,and anterior/anterior-posterior surgery were selected for C fractures.During follow-up,the improvement of neurological function was recorded and fracture healing and bone graft fusion were reviewed by imaging.Results:All 59patients were followed up with an average of 16.3months (range,6-25months).Twenty-four patients underwent anterior surgery,22 underwent posterior surgery,and 13underwent anterior-posterior surgery.Fifty-seven patients received a reduction of frac- ture/dislocation,and fracture healing and bone graft fusion were achieved at 6months after operation.Two patients with C fractures undergoing anterior surgery had fixation failed within 1month after operation,and received a second operation with ante- rior-posterior approach.There was no recovery in neurological function in 5ASIA grade A patients.In patients with incomplete spinal cord injury,the ASIA grades increased 1to 2grades.Conclusions:The choice of surgical approach for subaxial cervical spine fractures should foUow the principle of reconstructing the tension band and the stability of the facet joints on the basis of neurological decompression.Anterior surgery should be chosen for the A3(simple vertebral fracture)and B3(anterior tension band injury)fractures,posterior surgery should be performed for the B2(posterior tension band injury)fracture,and an- terior surgery and anterior-posterior surgery should be performed for C fractures.
作者
张阳
张志成
李放
李连华
张建政
刘智
孙天胜
ZHANG Yang;ZHANG Zhicheng;LI Fang;LI Lianhua;ZHANG Jianzheng;LIU Zhi;SUN Tiansheng(Department of Orthopedics,PLA Army General Hospital,Beijing100700,China)
出处
《中华骨与关节外科杂志》
2018年第9期646-650,共5页
Chinese Journal of Bone and Joint Surgery
关键词
下颈椎
脊柱骨折
手术入路
外科治疗
Subaxial Cervical Spine
Spinal Fractures
Surgical Approach
Surgical Treatment
