早期前后联合入路治疗下颈椎骨折脱位并脊髓损伤

Early operation with one-stage combined anterior and posterior approach in the treatment of fracture-dislocation of the lower cervical spine associated with spinal cord injury

目的观察前后路一期减压、植骨、内固定治疗脊髓前后方均受压的下颈椎损伤的疗效。方法对本组自2004年1月至2005年12月5例下颈椎骨折脱位并脊髓损伤接受手术治疗的患者,进行回顾性分析。其中后路椎板切除、前路椎间盘切除、植骨颈椎前路钢板内固定术2例;后路椎板切除、前路病椎次全切除、钛网植骨融合钢板内固定术1例;后路椎板切除小关节复位、小关节间植骨侧块钢板内固定术、前路椎间盘切除、植骨术内固定2例。结果脱位均获完全复位,脊髓获得有效减压,椎间植骨6个月后均获骨性融合。4例脊髓功能有不同程度恢复,术中无重要神经、血管、气管及食道损伤,未发生术后消化道应激性溃疡。结论早期前后联合入路治疗下颈椎骨折脱位并脊髓损伤安全、有效。

Objective To observe the effects of early operation with one-stage combined anterior and posterior approach in the treatment of fracture-dislocation of the lower cervical spine associated with spinal cord injury. Methods From January 2004 to December 2005,5 cases with fracture-dislocation of the lower cerrical spine associated with spinal cord injury received operative treatment were annalyzed retrospectively.Among them, 2 cases underwent posterior approach laminectomy,anterior approach removal of vertebral disc,bone grafting flxed by steel plate, 1 case underwent posterior approach laminectomy,anterior approach subtal pathological vertebral resection,titanic net bone grafting fusion with steel plate and 2 cases underwent posterior approach laminectomy, microjoint reduction,inter-microjoint bone grafting,lateral steel plate fixation, anterior approach removal of vertebral disc and bone grafting with fixation. Results Dislocations were reduced completely and effecive decompression of spinal cord was got in all cases, Bony fusion was got in the inter-vertebral space after 6 months.Spinal cord function had recovery in the different degree in 4 cases.No major nerve,blood vessel trachea and esophagus were injured during opertion.No stressing ulcer was occurred after operation. Conclusion Early stage combined anterior and posterior approach surgery are a safe and effective method for the treatment of fracture-dislocation of the lower cerrical spine associated with spinal cord injury.