闭合复位结合一期前后路内固定治疗下颈椎骨折脱位

Treatment of Fracture and Dislocation of Lower Cervical Spine with Closed Reduction and Primary Internal Fixation through Anterior and Posterior Approaches

目的探讨闭合复位结合一期前后路内固定手术治疗下颈椎骨折脱位的临床效果。方法采用闭合复位结合一期前后路内固定手术治疗新鲜下颈椎骨折脱位28例，男16例，女12例。术后随访8～31个月，平均15个月，定期摄X线片观察植骨融合和颈椎稳定性。以Frankel分级作为脊髓恢复情况的判断标准。结果术后检查证实植骨均在3-6个月内融合，颈椎稳定性好，无内固定松动脱出，脊髓功能平均提高1．1级。结论术前牵引复位，可以使大多数骨折脱位复位，安全有效。一期前后路内固定手术可使受伤节段达到术后即刻稳定，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 closed reduction and primary internal fixation through anterior and posterior approaches for the treatment of the fresh severe fracture and dislocation of the lower cervical spine. Methods Twenty - eight patients with the fresh fracture and dislocation of the lower cervical spine including 16 men and 12 women underwent primary decompression, bone grafting fusion and internal fixation through anterior and posterior approaches after traction and closed reduction. The followed up period ranged from 8 to 31 months with the average of 15 months. The X-ray film was taken periodically for observation of the fusion of the bone grafts and the cervical stability. The Frankel grading was used as the judging criteria for the recovery of the spinal cord. Results Fusion was found in all 28 patients between 3 and 6 months after the operation with good cervical stability. The average of 1.1 grade was increased according to the Frankel grading. No failure of the internal instruments or late cervical re - dislocation was found. Conclu- sionThe safe and satisfactory result can be achieved in majority of the patients with severe fracture and dislocation of lower cervical spine with the preoperative traction and closed reduction. The primary internal fixation through anterior and posterior approaches can offer immediate stability to the injured segments. This technique is of benefit to the patients for the functional recover of the spinal cord, the postoperative nursing and the rehabilitation.