23例下颈椎骨折脱位急诊前路手术治疗的临床分析

Clinical analysis of emergency operation of lower cervical fracture and dislocation by anterior approach in 23 cases

目的探讨下颈椎骨折脱位急诊前路手术治疗的价值,以便尽早恢复颈椎正常排列、彻底减压、重建颈椎即刻稳定性,解除对脊髓和神经的机械压迫,使患者能尽早进行康复训练及防止继发脊髓神经血管损伤,为脊髓神经损伤提供康复的有利条件。方法总结2001年3月～2006年5月收治的23例下颈椎骨折脱位临床资料,本组均在全麻下急诊行颈前路减压、复位、植骨及颈椎前路钢板固定。结果全部患者获得随访,时间6～27个月,平均13.5个月。植骨于术后12周均获得牢固骨性融合,颈椎椎间高度、生理曲度及颈椎稳定性维持良好,均获得完全复位。10例脊髓不完全性损伤者功能均获不同程度的改善,13例脊髓完全性损伤者临床症状(如疼痛、麻木等)得到缓解。结论下颈椎骨折脱位可行急诊前路手术,并能获得满意的复位和即刻稳定性的重建。

Objective To investigate the results of twenty-three cases with lower cervical fracture and dislo-cation treated with emergency operation by anterior approach to resume the cervical normal sequence, decompress completely and reconstruct immediately cervical stability as soon as possible, so as to reheve pressure to spinal cord and nerve and avoid the secondary trauma of spinal cord and nerve and blood vessel. Methods We summarize 23 cases of the patients with lower cervical fracture and dislocation, all patients were operated with anterior emergency decompression,fusion and internal fixation. Results All patients were followed up for 6-27 months（ average 13.5 months）. The normal intervertebral height and lordotic were maintained,and 10 cases with incomplete neurological defect were improved postoperatively. Conclusion The lower cervical fracture and dislocation can have emergent operation and the outcome is satisfactory.