陈旧性下颈椎骨折脱位的手术治疗(附42例报告)

Surgical management of old lower cervical fractures and dislocations(42 cases report)

目的探讨陈旧性下颈椎骨折脱位的发生原因、手术方法及临床疗效。方法2005年6月～2008年12月,借助椎体间撑开器经颈前路整复脱位椎体、椎体间植骨融合钢板内固定术以及颈后路整复脱位椎体联合应用前路椎体间植骨融合钢板内固定术治疗陈旧性下颈椎骨折伴脱位42例患者。其中,18例患者单纯经颈前路完成脱位颈椎椎体复位,24例前路整复失败病例联合颈后路整复脱位椎体并前路椎体间植骨融合钢板内固定术。观察术后颈椎的稳定性、植骨融合率及神经功能恢复情况。结果全部病例均获得解剖复位,颈椎生理弧度及椎间隙高度恢复正常,术中无神经损害加重及血管损伤等并发症发生,术后颈椎获得即刻稳定性。经6～48个月随访,椎间植骨均获得骨性愈合,螺钉无松动、退出或断裂,颈椎脱位矫正度无丢失,神经功能均有不同程度恢复。结论陈旧性下颈椎骨折脱位应先行前路整复,如失败再行后路手术整复脱位椎体并前路椎体间植骨融合内固定术,对于颈椎陈旧性骨折脱位仍强调恢复颈椎解剖对位的重要性。

Objective To investigate the cause,operative technique and clinical effect of old lower cervical fractures and dislocations.Methods From June 2005 to December 2008,42 patients with old cervical fractures and dislocations were treated with reduction of cervical dislocations and interbody autograft fusion and internal fixation with locking plate,including 18 patients treated with the help of intervertebral space distractor by anterior approach and 24 patients with lower cervical dislocations that could not be reduced by single anterior approach treated by anterior and posterior approach.Postoperative cervical spine stability,bone graft fusion rate and nerve function recovery were observed.Results Anatomical reductions were achieved in all the patients.The alignment of cervical spine and height of disc space were recovered well.The cervical spine was stabilized immediately after the operation.There were no complications of neurologic function deterioration or blood injuries.The follow-up time was from 6 months to 48 months,with an average time of 25.8 months.Bone unions were achieved in all the cases and no screws loosening,pulling out or breaking occurred.There was no loss of the reduction of cervical dislocations.The neurological functions in all the patients were recovered in various degrees.Conclusion The cervical reduction with the help of intervertebral space distractor by anterior approach should be advocated at first in treatment of old lower cervical fractures and dislocations.The cervical reduction,interbody fusion and fixation by anterior and posterior approach were applied in the patients with lower cervical dislocations that could not be reduced by single anterior approach.The significance of anatomical reduction of cervical spine and its stability should be emphasized.