颈椎360°手术治疗严重下颈椎骨折脱位

Circumferential surgery for severe fracture and dislocation of lower cervical spine

[目的]探讨颈椎一期前-后-前入路360°手术治疗严重下颈椎骨折脱位的临床疗效和应用价值。[方法]11例严重下颈椎骨折脱位患者,在颅骨牵引下经鼻腔气管插管全身麻醉下进行手术。首先采用仰卧位,经颈椎前路摘除脱位椎间的椎间盘和其他致压物;然后变换体位为俯卧位,经后路手术切开撬拨复位,采用侧块螺钉固定脱位椎节并植骨融合;最后将患者重新置仰卧位,经颈椎前路彻底清除残留的椎间盘和上下终板,常规髂骨块植骨及自锁钛板内固定。术后定期复查X线片以观察损伤节段的稳定性和融合率,以Frankel分级判定脊髓功能的恢复情况。[结果]术后11例患者全部获得随访,随访8～32个月,平均17.6个月。颈椎脱位均完全复位,无植骨不融合。未出现内固定断裂、松动及脱落,无血管、神经、食道损伤等并发症。无1例出现神经损伤加重,Frankel分级平均提高0.8级。[结论]颈椎一期360°手术治疗严重下颈椎骨折脱位,可以完全恢复颈椎序列,解除颈髓压迫,损伤节段术后获得即刻稳定,不易造成脊髓损伤加重,可为脊髓功能恢复创造有利条件。

[Objective]To investigate the clinical outcome and application value of single-stage circumferential surgery for severe fracture and dislocation of lower cervical spine.[Method]Eleven patients with severe fracture and dislocation of lower cervical spine were operated on under skull traction and general anaesthesia.Firstly,anterior approach was carried out and the intervertbral disc and other compressed segments were removed.When patients turned to prone position,posterior approach was taken and dislocation was reduced by hand while the dislocated vertebrae were fixed with mass screws and fused.When in supine position,the intervertbral disc and both upper and lower end plates were cleared for iliac autograft and plate internal fixation.X-ray was taken after operation to observe stability and fusion of the injured segments.Function of spinal cord was evaluated by Frankel grade.[Result]Eleven pationts were followed-up for 8 to 32 months（average,17.6 months）.All the patients got complete reduction and all the grafts got fused.There was no complication related to internal fixation breakage,loosening or displacement and there was no neurovascular or esophagus complications during the operation.No patients got worse function of spinal cord after operation and the function improved by 0.7 grade in average in Frankel grade.[Conclusion]Single-stage circumferential surgery for patients with severe fracture and dislocation of lower cervical spine could recover the sequence of the cervical spine and relieve the compression of spinal cord.The injured segments can gain postoperative immediate stability.This technique will not aggravate the injury of the spinal cord and it may be beneficial for functional recovery.