下颈椎牵张屈曲型损伤手术入路的选择及疗效分析

Choice of surgical approach for distraction-flexion injury to the lower cervical spine

目的回顾性分析不同手术入路治疗下颈椎牵张屈曲型损伤的疗效。方法回顾性分析自2002年8月至2008年8月手术治疗的30例下颈椎牵张屈曲型损伤患者，根据不同类型、是否合并椎间盘损伤和术前牵引复位情况选择不同的手术方法，其中前路手术7例，后路手术5例，前后联合入路手术18例。分析3组的损伤节段Cobb角、椎体水平移位的变化、神经功能恢复（Frankel评分）、融合时间、融合率、手术时间以及并发症情况。结果所有患者获得5～24个月（平均8个月）随访，均获得骨性愈合，无内置物松动发生。所有患者Frankel评分术前平均为1．67分，术后为2．22分。术前Cobb角平均为7．78°，术后为1．79°；水平位移术前平均3．67mm，术后恢复到0．53mm。前后联合入路手术时间和出血量与单纯前路或后路手术比较差异均有统计学意义（P〈0．05），但在融合时间、Cobb角、椎体水平移位、融合率、神经功能恢复、并发症等方面差异均无统计学意义（P〉0．05），且3组手术前后的Cobb角、椎体水平移位和神经功能恢复方面差异均有统计学意义（P〈0．05）。结论根据不同损伤情况选择不同手术入路治疗下颈椎牵张屈曲型损伤均可取得满意的疗效。手术入路的选择应根据关节突脱位、是否可以复位以及椎间盘损伤等情况综合考虑。

Objective To retrospectively compare the clinical results of 3 surgical approaches used in the treatment of distraction-flexion injury to the lower cervical spine. Methods Included in this analysis were 30 patients who had been treated surgically for a distraction-flexion injury to the lower cervical spine from August 2002 to August 2008. Seven of them were treated through anterior approach, 5 through posterior approach, 11 through posterior-anterior approaches and 7 through anterior-posterior-anterior approach. The different approaches were compared in terms of changes in transverse displacement and Cobb angle, neurologic recovery （Frankel criteria）, fusion time, fusion rate, surgery time, and complications. Results The mean follow-up was 8 （5 to 24） months. Bone fusion was obtained in all patients. No plate or screw loosening occurred. The mean Frankel score increased from 1.67 preoperatively to 2.22 postoperatively. The mean Cobb angle was 7.78° before operation and 1.79° after operation, and the transverse displacement was 3.67 mm before operation and 0. 53 mm after operation. The combined anterior and posterior approach resulted in significantly longer operation time and more blood loss than either the anterior or the posterior approach alone （ P 〈 0. 05） . There were no significant differences in the changes in transverse displacement and Cobb angle, fusion time, fusion rate, neurologic recovery or complications （ P 〉 0.05）. Conclusion Since all the different approaches can lead to satisfactory results, the choice of surgical approach should be based on the conditions of dislocated facet joint, reduction and iniury of the disc.