合并关节突交锁的下颈椎骨折脱位的前路手术△

Anterior surgical procedures for lower cervical fracture and dislocation accompanied with locked facets

摘要:

[目的]评价屈曲牵引下前路手术复位、减压和融合固定关节突交锁下颈椎骨折脱位的临床效果。[方法]2015 年 1 月—2019 年 1 月，采用屈曲牵引，前路开放复位，减压融合固定治疗关节突交锁下颈椎骨折脱位患者 45 例，男 33 例，女 12 例；年龄 29~64 岁，平均(48.6±7.2)岁。采用 NDI、JOA 评分、ASIA 分级，以及影像检查评估临床效果。[结果]45 例患者均顺利完成手术，关节突复位成功率为 100.0%，手术时间平均(65.4±22.8)min，切口长度平均(6.1±0.9)cm，术中出血量平均 (290.9±90.0) ml。随访时间平均 (2.7±1.1) 年，随时间推移，NDI 和 JOA 评分，以及 ASIA 评级较均显著改善 (P＜0.05)， 均未出现脊髓损伤加重表现。影像方面，与术前相比，术后椎间高度颈椎前凸 Cobb 角显著改善(P＜0.05)。未发现内固定物松动、移位、断裂等现象。[结论]屈曲牵引单纯前路复位、减压融合内固定术可有效治疗合并关节突交锁的下颈椎骨折脱位。

Abstract:

[Objective] To evaluate the clinical outcomes of anterior surgical procedures, involving reduction, decompression and in- strumented fusion under flexion traction for cervical fracture and dislocation accompanied with locked facets. [Methods] From January 2015 to January 2019, 45 patients, including 33 males and 12 females aged from 29 to 64 years with a mean of (48.6±7.2) years, underwent anterior surgical procedures, involving reduction, decompression and instrumented fusion under flexion traction for cervical fracture and dislocation accompanied with locked facets. Clinical outcomes were assessed by using NDI and JOA scores, ASIA scale, as well as radio- graphs. [Results] All the 45 patients had the operations completed successfully, with facet reduction rate of 100.0% , operation time of (65.4±22.8) min, incision length of (6.1±0.9) cm, intraoperative blood loss of (290.9±90.0) ml. As time went during the follow-up period lasted for (2.7±1.1) years, the NDI and JOA scores, as well as ASIA grades improved significantly (P＜0.05) . No patients showed any wors- ening of spinal cord injury during the follow-up period. Radiographically, the intervertebral height of the affected disc and the Cobb angle of cervical lordosis significantly improved postoperatively compared with those preoperatively (P＜0.05) . No loosening, displacement or frac- ture of the internal implant was found in anyone of them until the latest follow up. [Conclusion] The anterior surgical procedures, involving reduction, decompression and instrumented fusion, under flexion traction do effectively treat the lower cervical fracture and dislocation ac- companied with locked facets.