前路切开复位治疗下位颈椎骨折脱位

Anterior reduction and fixation for lower cervical fracture

目的探讨颈椎前路手术在治疗颈椎损伤中的应用价值。方法27例颈椎损伤患者术前不作复位牵引。采用颈椎前路切开复位、自体髂骨植骨及带锁钢板内固定术。观察植骨融合率、椎间高度和曲度维持情况,结合术前和术后1年Frankel神经功能评估方法了解手术疗效。结果27例均获得随访,时间12～37个月。植骨融合率100%,椎间高度和生理曲度在术后2个时间点差异无显著性,无手术相关并发症,无神经损伤加重现象。术后Frankel分级:A级1例无恢复;B级4例恢复至C级2例、D级1例,1例无恢复;C级6例恢复至D级4例、E级2例;D级14例恢复至E级11例,3例无恢复;E级2例仍为E级。结论颈椎前路带锁钢板治疗颈椎骨折脱位可显著提高植骨融合率,并有效维持椎间高度和颈椎生理曲度。经MR I检查确认无椎间盘突出者可以慎重选择后路手术,如同时合并椎间盘突出和椎板骨折者应考虑行前后路联合手术。

Objective To explore the effect of anterior reduction and fixation for treating lower cervical fracture. Methods A retrospective review was made in 27 lower cervical fractures. Without perioperative traction, all patients were treated by anterior reduction, autogenous iliac bone graft, and cervical spine locking plate fixation. The bone graft fusion rate and maintenance of intervertebral height were observed. All the cases were evaluated according to Frankel criteria of the neurol function preoperatively, and 12 months ＇after operation. Results 27 cases were followed up, and the average period of follow-up was 27.3 months. The fusion rate was 100% , and the intervertebral height and the physiological curve of cervical spine were no significant different between two time points ＇after operation. No deterioration of neurological injury or operation associated complication was observed. According to Frankel grading system, among the 27 patients with low cervical fracture, 1 at Grade A got no improvement;4 at Grade B were improved to Grade C in 2 and D in 1 ,and 1 got no improvement ; 6 at Grade C were improved at Grade D in 4 and 2 at Grade E in 2 ; 14 at Grade D were restored to E in 11, and 3 got no improvement. 2 at Grade E remained in Grade E. Conclusions Anterior operation is a safe and effective procedure for treatment of cervical fracture. Using cervical spine locking plate in low cervical fracture can increase the fusion rate of the bone graft and maintain the intervertebral height and physiological curve of cervical spine. It is important to select a suitable surgical approach according to different types of cervical fracture and dislocation.