下颈椎骨折脱位的手术方式选择与疗效分析

Surgical Approaches for Treatment of the Lower Cervical Vertebral Fracture and Dislocation

目的：探讨下颈椎骨折脱位的外科术式选择及手术治疗的临床疗效。方法：73例下颈椎骨折脱位伴颈髓损伤患者，采用前路、后路或前后联合入路进行下颈椎减压或重建，其中前路手术组40例，后路手术组26例，前后联合手术组7例。观察记录手术时间、术中出血量、平均固定节段、术中术后并发症、术后神经功能恢复和椎体复位情况等。结果：平均随访时间11．2个月，植骨于术后3～4个月内均获得骨性融合，无假关节、骨不连发生；术中均无脊髓、大血管、气管、食道等损伤；前路手术在手术时间、术中出血量及平均固定节段上少于后路手术；所有患者的术前JOA评分和颈椎复位参数较术后均有改善，差异有显著性意义（P〈0．05或P〈0．01）；结论：采用前路、后路或前后路联合入路手术治疗下颈椎不稳均可使损伤节段获得早期稳定，根据颈椎损伤机制、损伤部位及类型采取适合的手术入路是手术成功的关键。

Objective：To investigate surgical approaches for the treatment of the lower cervical vertebral fracture and dislocation. Methods ：The clinical data of 73 patients with the lower cervical vertebral injury combined with spinal from June 2003 to Augest 2008 were retrospectively analyzed. Anterior approach surgery procedure was performed in 40 cases, posterior approach in 26 cases, and combined anterior-posterior approach in 7 cases. The surgical time, blood loss, curve correction rate, surgery related complications, neurological function and reduction were all recorded. Results： The mean follow - up time was 11.2 months. Fusion was achieved in all patients in 3 or 4 months postoperatively. No pseudarthrosis or bone nonunion was observed. No injury of blood vessels, trachea, oesophagus and spinal cord were caused by surgery. The blood loss, surgical time and curve correction rate for anterior approach surgery were less than those for posterior cases. The average scores of JOA and reduction index were improved in all cases. Conclusion： For the treatment of the lower cervical vertebral fracture and disloacation, anterior approach, posterior approach and combined anterior-posterior approach can all achieve early stability. It is important to select a suitable surgical approach according to injury mechanisms, injury location and different types of cervical spine instability.