前后路联合手术治疗下颈椎陈旧性脱位21例临床研究

Anterior-posterior operation for old dislocation of inferior cervical vertebra:study in 21cases

目的探讨同期前后路联合手术治疗陈旧性下颈椎脱位的疗效。方法21例经颅骨牵引未能复位的陈旧性下颈椎脱位伴关节突交锁患者,在颅骨牵引下,先从后路松解关节突交锁与脊髓后方压迫,然后行前路减压、植骨内固定术。结果21例均完全复位,症状改善,无严重并发症发生。全部病例均获6个月以上随访,椎间植骨融合良好,颈椎生理曲度、椎间高度、颈椎的稳定性均维持良好,15例脊髓损伤患者中14例按Frankel分级有不同程度提高。结论同期前后路联合手术可完全恢复颈椎的序列和高度、解除脊髓压迫,是一种有效的治疗方法,但手术有一定风险,应严格掌握适应证,谨慎操作。

Objective To explore the effects of the treatment by anterior-posterior operation for old dislocation of inferior cervical vertebra. Methods 21 patients with dislocation of inferior cervical vertebra accompanying with facet locking and failed treatment by skull traction were involved. Posterior approach was used to relax facet locking and the rear spinal cord compression and anterior approach to decompress and plug bone graft by MESH. Results All the dislocated cervical vertebras had get reposition and all the patients＇symptoms get well without any serious complication. Follow-up of 6 months or more showd that every patient had get solid fusion with good curvature and height and stability,and 14 of the fifteen spinal injury patients had get Frankel grade raise. Conclusion For old dislocation of inferior cervical vertebra,anterior-posterior operation is effective. It can obtain satisfactory reduction and decompression and stability. But because of the risk, the operation must be used cautiously.