新鲜下颈椎骨折脱位伴关节突交锁的治疗

Evaluating the early treatment for acute subaxial cervical fracture-dislocation with locked-facet

目的探讨新鲜下颈椎骨折脱位伴关节突交锁的安全、简便和有效的早期治疗方法。方法回顾分析23例新鲜外伤性下颈椎骨折脱位伴关节突交锁的患者临床资料。所有患者在治疗前均行X线片和CT重建或MRI检查及ASIA神经功能评级。术前C级12例,D级6例,E级5例。患者于清醒状态下先行持续闭合颅骨牵引,然后进行动态ASIA神经功能评级及定时床边X线摄片。损伤至开始牵引的间隔时间平均为28h(5～51h),平均牵引重量为12kg(6～15kg),平均牵引时间为1.5h(0.5～5.5h)。复位成功后维持颅骨牵引并择期行颈前路手术。结果 23例患者均闭合复位成功,无1例出现神经功能下降。治疗后ASIA神经功能评级C级5例,D级10例,E级8例。平均提高1级以上。结论新鲜外伤性下颈椎骨折脱位伴关节交锁的患者应早期持续闭合颅骨牵引,同时进行动态ASIA神经功能评级及定时床边X线摄片,复位成功后,择期行颈前路手术。该方法简便、安全,疗效满意。

Objective To evaluate a simple,safe and effective early treatment for subaxial cervical fracture-dislocation with locked-facet.Methods Twenty-three cases were reviewed.These patients were all under consciousness condition and had been taken X-Ray plain films and MRI/CT re-construction examnations and classified according to American Spinal Injury Association（ASIA） neurological function grade before treatment.Twelve patients were in grade C,6 patients in grade D and 5 patients in grade E.The dynamic ASIA neurological function scale and bedside-radiography examnations had been taken regularly during the skull traction-reduction procedures.The average interval from the traumatic events to begin to skull traction-reduction was 28 hours（5-51 hours）,The average traction weight was 12kg（6-15kg） and average traction time was 1.5 hours（0.5-5.5 hours） before surgery.Results The ASIA scale for the patients was raised by more than one grade in average after the treatment.It was showed 5 patients in grade C,10 patients in grade D and 8 patients in grade E,respectively.23 cases all succeeded in reduction with no neurological deterioration.Conclusion Under the intensive dynamic ASIA neurological function grade and X-Ray examnations,the early and continued closed skull traction-reduction for treatment in patients with consciousness condition is important for performing selective anterior surgery depending on the patient＇s overall and local status to treat subaxial cervical fracture-dislocation with locked-facet.It is a safe and effective way to obtain better outcome.