床旁快速牵引复位在治疗颈椎脱位关节突交锁中的作用

Effects of bedside rapid skull traction in treatment of cervical dislocations with locked facet

目的探讨床旁快速牵引复位在治疗颈椎关节突脱位交锁中的作用，以期找到快速牵引的适用情况。方法回顾性分析1992年6月～2004年3月颈椎外伤致关节突脱位交锁术前行颅骨牵引快速复位的33例患者的临床资料。双侧关节突脱位交锁21例，单侧关节突交锁12例。常见脱位节段：C4.5 8例、C3.6，15例和C6.7 10例。所有患者均采用床旁颅骨牵引快速复位法，牵引复位成功者均采用颈椎前路间盘切除植骨融合；复位失败者行颈后路切开复位内固定术。结果双侧颈椎关节突脱位交锁者牵引复位成功率为85．7％，单侧颈椎关节突脱位交锁患者牵引复位成功率为16．6％，两组间差异有统计学意义（P〈0．01）。23例患者获平均21．6个月（13～36个月）随访。随访病例中植骨融合者均获骨性愈合，颈椎序列良好。结论床旁颅骨快速牵引复位法适用于双侧颈椎关节突脱位交锁患者；双侧关节突脱位交锁患者可先行颅骨快速牵引复位，复位后行颈前路间盘切除植骨融合术；单侧颈椎关节突脱位交锁患者宜行后路切开复位。

Objective To investigate the clinical results of close reduction by bedside rapid skull traction in treatment of the cervical dislocation with locked facet so as to make sure of the indications of craniocervical traction. Methods Thirty-three patients with cervical dislocation with locked facet following cervical injury were treated with rapid skull traction-reduction before operation from June 1992 to March 2004 in our department. Their clinical data were studied retrospectively. Results The common dislocation segments were C4, 5 ,C5, 6 and C6, 7 in 21 patients with bilateral locked facets and 12 with unilateral locked facet. Closed reduction was successful in 85.7% of the patients with bilateral locked facets and in 16. 6% of the patients with unilateral locked facet. All the cases who had obtained successful close reduction with skull traction underwent anterior discectomy plus graft fusion, while those who had unsuccessful close reduction underwent posterior open reduction and internal fixation. Conclusions Close reduction with bedside rapid skull traction is suitable for cervical dislocation with bilateral locked facets rather than for cervical dislocation with unilateral locked facet. Patients with dislocation with bilateral locked facets can be treated by skull traction firstly and then by anterior cervical discectomy and graft fusion, while those with unilateral locked facet should be treated by posterior cervical open reduction and internal fixation.