颈前路复位手术治疗难复性下颈椎脱位14例临床分析

Analysis on efficacy of anterior surgery on irreducible dislocation of the lower cervical spine

目的:探讨前路治疗难复性下颈椎脱位的复位方法、安全性及疗效。方法:对行颅骨牵引不能复位的14例下颈椎脱位均行前入路手术,对单侧脱位(9例)上下椎体,边撑开,边旋转,解开交锁,复位;对双侧脱位(5例)上下椎体,边撑开,边按压上位椎体,向下、前撬拔下位椎体,解开交锁,复位。继行植骨,前路钢板内固定。结果:术后随访3～48个月,1例C4脱位伴截瘫患者于术后1周因呼吸肌麻痹呼吸衰竭死亡;余13例中ASIA A级4例,治疗前后无变化;B级4例转为C级2例;C级3例转为D级;D级2例转为E级。结论:颈前路复位手术治疗难复性下颈椎脱位,可达到一期解开交锁而复位,避免前后联合入路或传统手术结合颅骨牵引等复杂操作,减少手术创伤和风险。

Objective：To explore the reduction,security,reliability and efficacy of anterior surgery on irreducible dislocation of the lower cervical spine.Methods：Fourteen cases of the lower cervical dislocation that could not be reduced by the skull traction received anterior surgery;nine cases of unilateral dislocation of the upper and lower vertebrae were distracted and rotated to untie the interlocking and then reduced;five cases of bilateral dislocation of the upper and lower vertebrae were distracted and depressed the upper vertebral body and pried the lower one to untie the interlocking and reduced,and then bone graft was performed and a steel plate was used for fixation.Results：The follow-up lasted from to 48 months.One case of C4 dislocation with paraplegia died one week after the operation because of respiratory muscle paralysis.The other 13 cases were evaluated according to ASIA Classification Standard： 4 cases which had no response to the therapy were classified as grade A,4 cases were classified as grade B,of which 2 cases improved and were elevated to grade C,3 cases were rated as grade C and then improved to grade D,and 2 cases were rated as grade D and then improved to grade E.Conclusions：The anterior surgery can untie the interlocking and reach reduction at one stage,which may avoid complicated operations such as associated approach of anterior and posterior surgery or traditional surgery with the skull traction,thus reducing surgical trauma and risk.