颈椎双侧关节突交锁的早期治疗

Early Treatment of Double Cervical Spine Locked Face

目的 提高颈椎双侧关节突交锁的治疗疗效。方法 对 3 0例颈椎双侧关节突交锁的病人 ,实施早期、快速大重量牵引 ,配合手法复位。并对其中 1 7例MRI证实合并椎管前有脱出的椎间盘压迫 ,均行前路减压植骨术 ,9例辅以颈前路钢板内固定 ,早期功能锻炼。结果 随访 2 8例 2～3年 ,1例出院后 8个月并发症褥疮而死亡 ,2 7例按ASIA分级 ,A级 5例 ,治疗前后无变化。B级 1 0例 ,转为C级 4例 ,C级 6例 ,转为D级 3例 ,D级 4例 ,均转为E级 ,E级 2例。结论 对颈椎双侧关节突交锁的治疗应早期颅环大重量牵引 ,配合手法迅速复位 ,彻底减压重建脊柱稳定性为原则。前路减压是最理想的手术方式。

Objective To improve the clinical effec t of double cervical spine locke d face. Method 30 double cervical spine locked face cases un derwent early,rapid and heavy-weight traction in combination with tact reposition. 17 cases confi rm ed by the MRI that accompanying with the disc constriction protruding from the f ront of the vertebral canal, which was treated with anterior decompression and r econstruction as well as early functional exercises, 9 cases of those with the he lp of the anterior locking plates at the same time. Result T he follow-up period was from 2 years to 3 years, including 28 cases. Bedsore re cu rred in 1 case and died after 8 months departing from the hospital.27 cases grad ed a ccording to ASIA, 5 cases in grade A, which made no difference after treatment; 10 cases in grade B, among those 4 cases transferred to grade C; 6 cases in gra de C, among those 3 cases transferred to grade D; 4 cases in grade D,which were all transferred to grade E; 2 cases in grade E. Conclusion The principle should be obeyed so that early, heavy-weight traction in combinat ion with rapid tact reposition could reduce the pressure completely and reconst ruct the stability of the spine when treated with double cervical spine locked face. Anterior decompr ession is a rational surgery method.