无脊髓损伤的陈旧性下颈椎骨折脱位的外科治疗

Suraical Management of Old Lower Cervical Spinal Fractures or Fractures and Dislocations without Spinal Cord Injury

目的:探讨无脊髓损伤的陈旧性下颈椎骨折脱位的手术治疗方法。方法:对9例无脊髓损伤的陈旧性下颈椎骨折或者骨折脱位患者,采用经前路伤椎椎体次全切除减压、复位、自体髂骨植骨融合及OrionTM钢板固定或采用一期前后路联合手术切开复位,椎间融合加OrionTM钢板固定融合的方法进行手术治疗。结果:术后全部病例经随访观察,症状获得改善,7例完全恢复,2例残留手指麻木。术后6个月全部返回工作岗位。颈椎椎间高度、生理曲度维持良好,无内固定失败等并发症。结论:对于无脊髓损伤的陈旧性下颈椎骨折脱位宜采用一期前后路联合手术切开复位、椎间融合加钢板内固定的方法,最大限度保留活动节段,恢复颈椎椎间高度和生理曲度,重建颈椎即刻稳定性;对于无脱位的骨折宜采用单纯前路手术,除可达到减压、复位、恢复椎间高度和生理曲度外,更重要的是可重建颈椎即刻稳定性,对防止继发性脊髓损伤有极其重要的作用。

ObiectiveTo study the optimal surgical treatment of old lower cervical spinal fractures and dislocations without spinal cord iniury.Methods Nine patients with cervical spinal fractures or fractures and dislocations without spinal cord injury were treated with anterior decompression, reduction,autogrft and Orion?plate fixation, or with one - stage anterior and posterior reduction, and Cage and Orion plate fixation. Results Of the 9 patients, who were improved in the clinical manifestations,7 got complete remission and 2 still felt finger numbness. At six months after the surgery,all the patients returned to their former work,and their in-tervertebral heights and physiological curves were kept well and there were no internal fixation failure. Conclusions One - stage anterior and posterior reduction, and Cage and Orion plate fixation may be applied to old lower cervical spine fractures and dislocations without spinal cord injury, because they can retain most motive segments, recover intervertebral heights and physiological curves and reconstruct stability of cervical spine. The cervical fractures without dislocation should be treated by anterior approach surgery because the complete decompression, good reduction, excellent maintenance of intervertebral heights and physiological curves, and immediate stability of the cervical spine can be achieved and the injury secondary to spinal cord will be avoided by it.