Ⅰ期前后路联合手术治疗严重下颈椎骨折脱位

One-stage combined anterior-posterior decompression and internal fixation for the severe fracture and dislocation of lower cervical spine

[目的]探讨Ⅰ期前后路联合手术固定在严重下颈椎骨折脱位中的临床疗效和应用价值。[方法]采用颈椎前路钢板和后路侧块钉棒Ⅰ期联合复位内固定技术治疗严重下颈椎骨折脱位27例，手术均在颅骨牵引下经鼻腔气管插管全身麻醉下进行，先采用俯卧位，植入侧块螺钉、减压、复位后，植入棒，运用“弓弦原理”，采用CD旋棒技术恢复颈椎的序列，维持并稍加大颈椎在矢状面上的生理前凸，植骨融合后拆除颅骨牵引置仰卧位，行前路椎体复位、减压、植骨及自锁钛板固定。术后定期复查X线片以观察损伤节段的稳定性和融合率，以Frankel分级判定脊髓功能的恢复情况。[结果]术后27例全部获得随访，随访6—27个月，平均11．6个月。脱位均完全复位，无植骨不融合。损伤节段稳定，颈椎椎间高度及生理曲度都得到良好重建及维持，未出现内固定断裂、松动及脱出，无血管、神经、食道损伤等并发症。除5例A级、2例B级脊髓功能无恢复，Frankel分级无变化外，其余Frankel分级平均提高1．8级，其中5例患者达到E级。[结论]颈椎Ⅰ期前后路联合手术固定治疗严重下颈椎骨折脱位，完全恢复颈椎序列，复位良好，椎管前后方压迫得到彻底解除，损伤节段术后获得即刻稳定，方便术后护理和功能锻炼，有利于脊髓功能恢复，为一积极有效的方法。

[ Objective] To investigate the clinical effects and value of one-stage combined anterior-posterior decompression and internal fixation for the severe fracture and dislocation of lower cervical spine. [ Method ] Twenty-seven patients of severe fracture and dislocation of lower cervical spine were treated with one-stage combined cervical anterior plate and posterior lateral mass screw and rod systems reduction and internal fixation technique in our hospital from January 2001 to January 2006. All the patients were operated under skull traction and in general anaesthesia. Firstly, the posterior approach was carried out. After inserting the mass screw, decompression and reduction, the author embedded the rod, adopted the principle of bow-string and applied the technique of CD rotating-rod to recover the sequence of the cervical and keep or increase the physiology anterior-protruding of the cervical on the sagittal plane. After grafting,the author removed the skull traction and initiate the anterior anterior reduction , intervertebral decompression , anto-graft and cervical spine auto-locking plate fixation. The stability and fusion rate of the injured segments were observed on the regular postoperative X-ray film. The function of the spinal cord was evaluated with Frankle classification. [ Result] Twenty-seven cases were followed-up from 6 months to Twenty-seven months （mean 11.6 months）. All patients got completely reduction, and all grafts got fused. The injured segments were stable, the cervical intervertebral height and lordosis were reconstructed and maintained, and there was no complications related to internal fixation breakage, loosening or displacement, there was no neurovascular and esophagus complications during the operation. Except the spinal cord function of the 3 Frankel A cases and 1 Frankel A case gained no recovery, the Frankle classification had no change, the spinal cord function of the others improved by 1.7 grade in average, and 5 cases achieved Frankel E. [ Conclusion] One-stage combined anterior-poste-rior decompression and internal fixation for the pateints with severe fracture and dislocation of lower cervical spine could recover the sequence of the cervical and obtain good reduction. It also gives a completely decompression. The injured segments can gain postoperative immediate stability. This technique is benefit to the patients for the functional recovery of the spinal cord , postoperative nursing and early rehabilitation. It is a positive and effective method.