下颈椎爆裂骨折合并脊髓损伤的手术治疗

Surgical treatment for burst fractures of subaxial cervical spine combined with spinal cord injury

目的评估手术治疗下颈椎爆裂骨折合并脊髓损伤的临床效果。方法回顾性分析自2002年以来收治的12例下颈椎爆裂骨折合并脊髓损伤的临床资料。伤后2~8 d,4例采用前路减压植骨融合内固定术,8例采用1期前-后联合减压植骨融合内固定术。采用ASIA分级评估神经功能,用放射学方法评估植骨融合情况,记录围手术期并发症。结果平均随访11.2个月。1例伤后2 d接受手术,术后死亡,6例术后发生并发症,经对症处理治愈。3例术后需要机械通气支持。7例患者有不同程度神经功能恢复（ASIA分级提高1~2级）。随访期间未见内固定失败者。结论手术治疗下颈椎爆裂骨折可以达到神经组织减压和重建颈椎稳定性的目的 ,根据具体病情可以选择单纯前路手术或者1期前后路联合手术。

Objective To evaluate the therapeutic effects of surgical treatment for burst fractures in subaxial cervical spine combined with spinal cord injury（SCI）.Methods The clinical data of 12 patients with burst fractures in subaxial cervical spine combined with SCI in our department since January,2002 were retrospectively studied.Within two to eight days after the injury,four patients underwent anterior cervical decompression and fusion while the other eight cases underwent one stage anterior-posterior combined surgery.American Spinal Injury Association（ASIA） grade was used to evaluate the neurological status and radiological exam was employed to evaluate the fusion.Perioperative complications were recorded.Results The follow-up averaged 11.2 months.One patient died after performing the surgery,six patients experienced minor complications postoperatively and ultimately being cured,three patients required transient supportive mechanical ventilation and seven patients made improvements in neurological function with ASIA grade raising one or two levels.No hardware failure was detected in the follow-up.Conclusion Surgical treatment for burst fractures of subaxial cervical spine combined with SCI could reduce the pressure of neurological tissue and reconstruct the stability of the cervical spine.Anterior surgery or anterior-posterior combined surgery could be performed according to the individual condition.