不同手术入路治疗无椎体骨折的下颈椎小关节脱位

Operative Treatment of lower cervical facet dislocation without vertebral body fracture through different approach

目的探讨不同手术入路治疗无椎体骨折的下颈椎小关节脱位的临床效果。方法回顾性分析34例无椎体骨折的下颈椎小关节脱位伴不同程度颈髓损伤患者,其中单侧小关节脱位7例,双侧小关节脱位27例。采用美国脊髓损伤协会（American Spinal Injury Association,ASIA）分级：A级5例,B级8例,C级12例,D级7例,E级2例。行前路、后路或前后联合入路进行减压、复位、内固定及融合,其中前路手术9例,后路手术14例,前后联合手术11例。结果术中无大血管、气管、食道及脊髓损伤发生。术后平均随访时间为16.2个月,植骨于术后3~4个月均获得骨性融合。前路手术的手术时间、术中出血量及平均住院费用均少于后路和前后联合入路手术。脊髓损伤患者术后神经功能等级均提高1或2级,不同入路手术术后神经功能恢复程度没有差别。结论采用前路、后路或前后联合入路手术治疗无椎体骨折的下颈椎小关节脱位均可使损伤节段获得早期稳定,神经功能明显恢复。根据颈椎损伤机制、损伤部位及类型选择适合的手术入路是手术成功的关键。

Objective To investigate the effect of operative treatment of lower cervical facet dislocation without vertebral body fracture through different approaches.Methods Clinical data of 34 patients of lower cervical facet dislocation without vertebral body fracture were analyzed retrospectively.There were 7 cases with unilateral facet dislocation,27 cases with bilateral facet dislocation.According to American Spinal Injury Association（ASIA） grades,5 cases were in grade A,8 cases were in grade B,12 cases were in grade C,7 cases were in grade D and 2 cases were in grade E.All patients had surgical reduction,decompression,stabilization and fusion,9 cases in anterior approach,14 cases in posterior approach and 11 cases combined anterior and posterior approach.Results There were no great vessels,trachea,esophagus or spinal cord iatrogenic injury.All patients were followed up for 12-35 months,the mean follow-up time was 16.2 months.Solid fusion were obtained in all patients at 3-4 months postoperative.Comparing the operation time,quantity of bleeding and medical fee,the patients underwent single anterior approach operation were fewer than the other 2 groups.The most patients with incomplete spinal cord injury gained neurologic improvement on average 1-2 ASIA grade after surgery.The neurologic improvements were all same in 3 groups.Conclusion Reasonable operative approaches should be adopted to treat lower cervical facet dislocation of without vertebral body fracture.An ideal anatomy reduction,solid bone fusion and the neurologic improvements can be obtained with either anterior,posterior approach or combined approach surgery.It is important to select a suitable surgical approach according to injury mechanism,position and type of joint for the treatment of lower cervical spine facet dislocation.