两种术中复位方式治疗绞锁性下颈椎骨折脱位△

Comparison of two techniques for intraoperative reduction of locked low cervical fracture and dislocation

摘要:

[目的]比较推送螺钉及改良撑开复位下前路椎体次全切除减压植骨融合治疗关节突绞锁性颈椎骨折脱位的临床疗效。[方法] 回顾性分析 2014 年 8 月—2019 年 9 月收治的 128 例关节突绞锁性下颈椎骨折脱位患者的临床资料，依据术前医患沟通结果，67 例采用推送复位，61 例采用撬拨复位，复位后均行椎体次全切除植骨融合内固定术。比较两组患者围手术期情况、随访和影像学资料。[结果] 两组患者均顺利完成手术。早期并发症率推送组为 8.96% (6/67)，撬拨组为 21.31% (13/ 61)，差异无统计学意义(P＞0.05)。两组手术时间、切口长度、术中失血量、术中透视次数、住院时间的差异均无统计学意义 (P＞0.05)。两组患者去除外固定时间及完全负重时间比较差异无统计学意义(P＞0.05)；随时间推移，两组患者术后 ASIA 感觉评分、ASIA 运动评分、JOA 颈椎评分均显著增加，且术后 6 个月和末次随访时，推送组上述评分均显著优于撬拨组，差异具有统计学意义(P＜0.05)。影像方面，术后 6 个月和末次随访时两组患者颈椎前弧线、局部成角、C2~C7 前凸角均较术前显著改善 (P＜0.05)，术后 6 个月及末次随访时，两组间上述影像指标的差异均无统计学意义 (P＞0.05)。[结论] 与撬拔复位相比， 推送复位术后神经功能改善更佳。

Abstract:

[Objective] To compare the clinical efficacy of distraction reduction versus prying reduction combined with anterior corpec-tomy and instrumented fusion for locked low cervical fracture and dislocation. [Methods] A retrospective study was done on 128 patientswho underwent surgical treatment for locked low cervical fracture and dislocation from August 2014 to September 2019. According to conse-quence of the preoperative doctor-patient communication, 67 patients received distraction reduction (the DR group) , while the other 61 pa-tients underwent prying reduction (the PR group) . After reduction, all patients were treated with anterior corpectomy and instrumented fu-sion. Perioperative conditions, follow-up and imaging data were compared between the two groups. [Results] All patients in both groupswere successfully operated on. The early complication rate was of 8.96% (6/67) in the DR group, whereas 21.31% (13/61) in the RPgroup, which was not statistically significant (P=0.05) . There were no significant differences in operative time, incision length, intraoper-ative blood loss, intraoperative fluoroscopy times and hospital stay between the two groups (P＞0.05) . In addition, there were no significantdifferences in the time to remove external fixation and the time to resume full weight-bearing activity between the two groups (P＞0.05) .The ASIA sensory score, motor score and JOA cervical spine score in both groups significantly increased over time (P＜0.05) , which in theDR group were significantly better than those in the PR group at 6 months after surgery and the latest follow-up (P＜0.05) . Radiographical-ly, anterior cervical arc, local angulation and C2~C7 lordosis significantly improved in both groups at 6 months postoperatively and at the lat-est follow- up compared with those preoperatively (P＜0.05) . However, there were no statistically significant differences between the two groups in terms of abovesaid radiographic items at 6 months after surgery and the latest follow-up (P＞0.05) . [Conclusion] The distraction reduction is considerably more conducive to improvement of nerve function than the prying reduction for locked low cervical fracture and dislocation.