摘要
目的探讨全身麻醉下手法牵引复位联合颈前路减压植骨融合内固定术治疗颈椎骨折脱位的疗效。方法回顾性分析自2015-01—2016-01诊治的62例颈椎骨折脱位,在全身麻醉下行手法牵引复位,复位时需要注意牵引的方向和牵引的力度,颈椎骨折脱位复位满意后尽量选择行一期颈椎前路椎间盘切除减压植骨融合内固定术。结果本组手术时间平均92(78～120)min,术中出血量平均80(50～300)ml。术后切口均一期愈合,均未发现切口感染。10例需要气管切开并转入ICU监护。术后8例出现不同程度腹胀,5例出现低蛋白血症,5例吞咽困难,均对症处理。62例均获得随访,随访时间平均18(12～24)个月。随访期间影像学检查显示椎间融合率达到100%,无假关节形成。末次随访时ASIA评分:A级5例,B级18例,C级10例,D级20例,E级9例。结论全身麻醉下手法牵引复位可提高颈椎骨折脱位复位成功率,复位后再行颈前路减压植骨融合内固定术,可缩短手术时间、简化手术方式,并且不会加重脊髓损伤。
Objective To explore the effect of the manual traction combined with anterior cervical decompression and fusion (ACDF) in the treatment of cervical fracture and dislocation under general anesthesia. Methods A retrospective analysis was made for 62 cases of cervical spine fracture and dislocation from January 2015 to January 2016. Manual traction reduction under general anesthesia was performed. Attention should be paid to the direction and strength of traction during reduction. After satisfactory reduction of cervical spine fracture and dislocation, one-stage ACDF were selected as far as possible. Results The average operation time was 92 (78-120) minutes and the average amount of bleeding was 80 (50-300) ml. All incisions healed in one stage after operation, and no incision infection was found. Ten patients needed tracheotomy and were transferred to ICU after surgery. Postoperative abdominal distension occurred in 8 cases, hypoproteinemia in 5 cases and dysphagia in 5 cases. All cases received symptomatic treatment. All 62 cases were followed up for 12 to 24 months, with an average of 18. During the follow-up period, imaging examination showed that the rate of intervertebral fusion was 100%, and no pseudoarthrosis was found. At the last follow-up, ASIA scores were: grade A in 5 cases, grade B in 18 cases, grade C in 10 cases, grade D in 20 cases and grade E in 9 cases. Conclusion Manual traction reduction under general anesthesia can improve the success rate of reduction of cervical spine fracture and dislocation. Successful reduction with ACDF can shorten the operation time, simplify the operation method, and will not aggravate spinal cord injury.
作者
罗益滨
王新伟
陈德玉
LUO Yi-bin;WANG Xin-wei;CHEN De-yu(Department of Orthopedics,Shanghai Changzheng Hospital,Second Military Medical University,Shanghai 200003,China)
出处
《中国骨与关节损伤杂志》
2019年第3期233-236,共4页
Chinese Journal of Bone and Joint Injury
基金
国家自然科学基金(81472128)
