创伤性下颈椎不稳定手术治疗的回顾性分析

The retrospective analysis of surgical treatment for traumatic instability of subaxial cervical spine

目的探讨并分析手术治疗创伤性下颈椎不稳定的原则、策略和预后评估。方法共83例创伤性下颈椎不稳定患者，采用Allen—Fergurson分类法并结合患者的全身及局部状况确定相应的治疗原则和策略。采用前路、后路或联合入路进行下颈椎的减压和重建。结果平均随访3年9个月；屈曲-牵张和屈曲-压缩型为最常见的损伤类型；前路、后路或前后联合入路手术分别占46、28和9例，无一例采用前-后-前的三期入路手术。JOA、VAS和ASIA运动功能指数的平均评分分别从术前的11、2、7、8和53、5分改善为最终评分时的15．3、2．6和67．8分；放射学参数平均值术后均有不同程度改善。所有的手术节段均完全融合，发生术后并发或合并症12例。结论应根据患者的全身情况和局部病理解剖制定个体化治疗方案。

Objective To evaluate and analyze a therapeutic principle and strategy to treat the traumatic instability of subaxial cervical spine as well as the prognosis assessment. Methods According to the Allen-Fergurso＇s classification, 83 patients who suffered from the traumatic instability of subaxial cervical spine were performed operations depending on the patients＇s general health, the local pathological anatomy and neurological function, including both the decompression and reconstruction maneuvers through anterior, posterior or combined approach. Results The average follow-up was 3 years and 9 months. The distraction-flexion and compression-flexion were the most frequent injury subtypes. There were 46, 28 and 9 operations through anterior, posterior or combined approach respectively. No operation through anteriorposterior-anterior approach occurred. The average scores of JOA, VAS and ASIA motor index improved from 11.2, 7. 8 and 53. 5 before operation, to 15. 3, 2.6 and 67.8 at the final follow-up, respectively. After operation, there were different extent improvements of average radiologic parameter. Fusion was achieved in all patients and 12 complications occurred. Conclusions According to both the patients＇s general health and the local pathological anatomy, individual therapeutic designing should be determined to treat the traumatic instability of subaxial cervical spine.