一期前后联合手术固定治疗严重下颈椎骨折脱位

One-stage combined anterior-posterior decompression and internal fixation for the severe fracture and dislocation of lower cervical spine

目的 探讨一期前后联合手术固定治疗严重下颈椎骨折脱位的效果。方法 12例严重下颈椎骨折脱位患者采用一期前后联合手术复位、减压和内固定。其中前路采用Orion带锁钢板 5例 ,Zephir带锁钢板 7例 ;前路减压后采用自体骨移植 4例 ,采用钛网加自体骨移植 8例 ;后路均采用Axis钛板螺钉 ,其中采用侧块螺钉 4例 ,颈椎椎弓根螺钉 8例。结果 术后随访 4～ 18个月 ,神经功能均有一级以上改善 ,其中有 3例FrankelC级患者术后接近E级。未见内植物松动、脱落及断裂者 ,植骨在 3～ 4个月内融合 ,未出现与手术固定技术直接相关的并发症。有 1例发现椎弓根螺钉紧靠椎间孔上缘进入椎体 ,但无神经损伤症状。结论 颈椎前后路一期联合手术固定严重下颈椎骨折脱位可使损伤节段获得早期稳定 ,方便术后护理和功能锻炼 ,有利于脊髓功能的恢复。

Objective To investigate the effects of one-stage combined anterior-posterior decompression and internal fixation for the severe fracture and dislocation of lower cervical spine.Methods Twelve patients with severe fracture and dislocation of the lower cervical spine were treated by single-stage combined anterior-posterior decompression and internal fixation.The anterior procedures included Orion(5 cases) and Zephir(7 cases) plating, bone autograft(4 cases) and titanium rete and autograft implantation(8 cases) after decompression.The posterior procedures included Axis titanium plate and screws fixation(4 cases with lateral mass plating,8 with pedicle screws fixation).Results All patients were followed up for 4～18 months.The function of the spinal cord was improved more than one grade after operation according to the Frankle classification.3 cases were improved from Frankle C to near E.No implant looseness, seperation or breakage was found.The bone graft fused in 3～4 months.No complication direct related to the surgery was found.The screw trajectory was just adjuvant to the superior rim of foramina in 1 case without neurologic symptom.Conclusion The immediate stability of the injured segments can be obtained by the combined anterior and posterior internal fixation for the pateints with servere lower cervical fracture and dislocation.The technique is benefit to the patients for the functional recovery of the spinal cord,postoperative nursing and early rehabilitation.