前路和后路入路联合内固定手术治疗下颈椎骨折脱位并脊髓损伤的临床观察

Clinical Observation of Anterior and Posterior Path Combined with Internal Fixation for Treating the Patients of Lower Cervical Fracture-dislocation with Spine Cord Injury

目的观察下颈椎骨折脱位伴脊髓损伤手术方法及临床疗效。方法 32例下颈椎骨折脱位伴脊髓损伤患者给予颈椎前路和后路入路联合内固定手术治疗,评价手术前后脊髓损伤程度、术后并发症情况。结果 32例患者治疗后Franke1分级平均提高1～2级,D～E级所占比例为62.5%,显著高于治疗前的水平(34.4%),相比较差异有统计学意义(P<0.05)。治疗后ASIA评分为(79.48±17.61)分,显著高于治疗前的评分,相比较差异有统计学意义(P<0.05)。所有患者的椎体复位、颈椎生理曲度恢复、椎间高度恢复均效果理想,随访未出现并发症。结论颈椎前后联合内固定手术治疗下颈椎骨折脱位伴脊髓损伤临床疗效好,值得临床推广。

Objective To observe the surgical methods and clinical efficacy of anterior and posterior path combined with internal fixation for treating the patients of lower cervical fracture-dislocation with spine cord injury.Methods Thirty-two lower cervical fracture-dislocation patients complicated with spine cord injury were treated by anterior and posterior path combined with internal fixation.The spinal cord injury was evaluated before and after the surgery.The postoperative complications were observed.Results After the treatment,the Franke1 grades of 32 patients were averagely increased 1～2 grades,the proportion of D～E classes was 62.5%,which was significantly higher than that of the pre-treatment level（34.4%）,and the difference was statistically significant（P〈0.05）.After the treatment,the ASIA score was（79.48±17.61）,which was significantly higher than that of the pre-treatment level,and the difference was statistically significant（P〈0.05）.The vertebra reduction,restoration of cervical lordosis,and intervertebral height of cervical spine achieved optimal effects.No complication was found during the follow-up period.Conclusions The anterior and posterior path combined with internal fixation for treating the patients with lower cervical fracture-dislocation complicated with spine cord injury has exact clinical efficacy,and it is worthy to be popularized.