下颈椎骨折脱位的手术入路和固定方法选择

Selection of Surgical Approach and Fixation Instrument in Treatment of Fracture and/or Dislocation of Lower Cervical Spine

目的探讨治疗下颈椎骨折脱位的手术入路和内固定方式的选择原则。方法回顾性分析61例下颈椎骨折脱位手术治疗的临床资料。ASIA评分:A级28例,B级3例,C级22例,D级8例,61例均经复位、椎管减压、植骨内固定治疗,其中50例采用前方入路及钛板内固定,11例采用后方入路及颈椎弓根钉内固定。结果术后随访12～36个月,平均18个月。术后12周均获得骨性融合,不完全性脊髓损伤患者术后神经功能有一定恢复,平均ASIA评分提高1～2级。结论必须根据不同的颈椎损伤的类型,选择采用前路或后路手术以及相应的内固定物。

Objective To investigate the principle on selection of surgical approaches and fixation instrument in the treatment of fracture and/or dislocation of lower cervical spine. Methods The clinical data of 61 patients with lower cervical spine fracture or dislocation were retrospectively analyzed.According to American Spinal Injury Association（ASIA） grading critria, 28 patients were in A grade, 3 in B grade, 22 in C grade and 8 in D grade.Surgical reduction, decompression,internal fixation and fusion were performed on all patients.Among them, 50 cases of operative procedures were done through anterior approach and fixed with anterior fusion plate; 11 cases were done through posterior approach and fixed with cervical pedicle screw system. Results All patients were followed up in 12 to 36 months,and the mean follow-up time was 18 months.Fusion was achieved in all patients at an average period of 12 weeks postoperatively.Incomplete spinal cord lesions improved on average 1 N2 ASIA grade after surgery. Conclusion For lower cervical spine fracture and/or dislocation, an ideal anatomic reduction can be obtained with either anterior or posterior approach surgery.It is important to select a correct surgical approach according to different types of cervical fracture and dislocation.