显微镜辅助治疗下颈椎骨折脱位并脊髓损伤

Microscopy-assisted decompression and instrument fusion for lower cervical fracture and dislocation complicated with spi⁃ nal cord injury

摘要:

[目的] 比较显微镜辅助与直视下减压固定融合术治疗下颈椎骨折脱位并脊髓损伤的临床疗效。[方法] 2016 年 1 月—2018 年 1 月 74 例下颈椎骨折脱位并脊髓损伤患者纳入本研究，40 例采用显微镜下减压融合固定（显微组），34 例采用常规减压融合固定（常规组）。比较两组围手术期、随访及影像资料。[结果]所有患者均成功完成手术，显微组术中出血量、切口长度、术中透视次数、下地行走时间、住院时间均显著优于常规组（P＜0.05），但手术时间显著长于常规组（P＜0.05）。显微组早期并发症发生率显著低于常规组 （P＜0.05）。所有患者均获随访 （3.1±0.5） 年。两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）；随时间推移，两组 VAS 和 JOA 评分，以及 Frankel 指数均显著改善（P＜0.05）；但是相应时间点，两组间上述指标的差异均无统计学意义 （P＞0.05）。 影像方面，两组术后 3 个月、末次随访伤椎前缘高度比均较术前显著增加 （P＜ 0.05），局部 Cobb 角均较术前显著减少（P＜0.05），相应时间点两组间上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 显微镜辅助减压融合固定治疗下颈椎骨折脱位并脊髓损伤具有创伤小、术后并发症发生率低的优势。

Abstract:

[Objective] To compare the clinical efficacy of microscopy-assisted versus direct-vision decompression and instrumented fusion for lower cervical fracture and dislocation complicated with spinal cord injury. [Methods] From January 2016 to January 2018, 74 patients with lower cervical spine fracture and dislocation complicated with spinal cord injury were enrolled in this study. Of them, 40 pa- tients were treated with microscopic decompression and fusion fixation (the MS group), while the remaining 34 patients received convention- al direct-vision decompression and fusion fixation (the DV group). The perioperative period, follow-up and imaging data were compared be- tween the two groups. [Results] All patients in both groups had operation completed successfully. The MS group proved significantly superi- or to the DV group in terms of intraoperative blood loss, incision length, intraoperative fluoroscopy times, postoperative ambulation time and hospital stay (P＜0.05), but the former consumed significantly longer operation time than the latter (P＜0.05). In addition, the MS group had significantly lower incidence of early complications than the DV group (P＜0.05). With time of follow-up lasted for (3.1±0.5) years, VAS and JOA scores, as well as Frankel index, improved significantly in both groups (P＜0.05). However, there was no significant difference in the above items between the two groups at any corresponding time points (P＞0.05), furthermore, there was no a significant difference in the time to resume full-weight bearing activity between the two groups (P＞0.05). Radiographically, the ratio of anterior height of injured vertebrae significantly increased (P＜0.05), whereas the local kyphotic Cobb angle significantly decreased in both groups at 3 months after operation and at the last follow-up compared with those preoperatively (P＜0.05), which proved not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] Microscopy-assisted decompression and instrumented fusion for lower cervical frac- ture and dislocation accompanied with spinal cord injury have the advantages of less trauma and lower incidence of postoperative complica- tions.