下颈椎骨折脱位的前路手术治疗

Anterior Approach for Treatment of Lower Cervical Spine Fracture and Dislocation

目的：探讨下颈椎骨折脱位前路手术的治疗优点及疗效。方法：对35例下位颈椎骨折脱位采用前路复位，术中不能完全复位者行伤椎椎体次全切除后复位，同时行自体骨植骨和／或钛网、钢板内固定。结果：所有病例均获完全复位，术后神经功能获得不同程度的改善。随访12月～3a，平均随访14个月，术后1～5月植骨融合（平均3．2月），随访时颈椎椎间高度、生理曲度维持良好，无钢板、螺钉折断、滑脱等并发症。结论：颈前路手术治疗下颈椎骨折脱位，可充分减压、复位、恢复颈椎椎间高度和生理曲度，更重要的是可重建颈椎的即刻稳定性，防止继发性脊髓损伤，有利于神经功能恢复。

Objective：To explore the value of anterior approach in the surgical treatment of cervical fracture and dislocation. Methods：35 cases of lower cervical fractures and dislocations, including 15 in falling injury , 14 in traffic accident injury, 8 in other injury, were treated with anterior decompression, reduction, autograft or mesh cage and plate fixation. Results：The mean follow-up period was 14 months. All cases were improved and obtained solid fusion within 3 months, 20 cases of which got normal day＇s work and 10 cases could take care of themselves in ordinary living. The intervertebral heights and physiologic curves were kept well, without plate or screw complications occurring in these cases. Conclusions ：It is feasible to get complete decom- pression, good reduction and excellent maintenance of intervertebral heights and physiologic curves by employing anterior approach to treat lower cervical fractures and dislocations. More important, it can get immediate stabilization to cervical spine and prevent secondary injury to spinal cord and recover nervous function. One or two stages posterior approaches were recommended to treat the patients who have posterior compression or difficult reduction.