早期大重量颅骨牵引快速复位在下颈椎骨折脱位中的应用

Rapid Reduction of Lower Cervical Spine Fracture-Dislocation with Gradually High Weight Skull Traction on Early Stage

目的:探讨早期渐进性大重量颅骨牵引快速复位在下颈椎骨折脱位并关节突交锁治疗中的作用。方法:自2003年1月-2007年7月共收治下颈椎骨折脱位并关节突交锁患者26例,所有患者均在清醒状态及持续心电监护、C臂透视下,于颈部屈曲位行早期渐进性大重量颅骨牵引快速复位,牵引起始重量10kg,每5min左右增重1-2kg,直至复位。复位成功后择期手术治疗。复位前、后按ASIA神经功能分级方法行脊髓功能评定。结果:所有患者均复位,平均复位牵引重量28kg(14-49kg),平均牵引时间58min(20-140min),牵引过程中无1例脊髓神经损伤加重、生命体征异常。复位后脊髓神经功能有不同程度恢复。结论:早期渐进性大重量颅骨牵引快速复位下颈椎骨折脱位并关节突交锁,是一种安全、简单及有效的方法,可为脊髓损伤的恢复及下一步的手术治疗创造良好的条件。

Objective： To elucidate the availability and clinical results about rapid reduction of lower cervical spine fracture-dislocation with gradually high weight skull traction on early stage.Methods： From January 2003 to July 2007,26 cases of lower cervical spine fracture-dislocation received treatment in our department.Monitoring under X-ray fluoroscopy and electrocardiogram,gradually high weight skull traction was performed on these patients at a flexion position on early stage.Reduction began with application of 10 kg of weight,and the weight was gradually increased by 1-2 kg every 5 minutes until reduction was obtained.Then the anterior operation would be performed under the best condition.The spinal function was evaluated according to ASIA neurological function scale before and after reduction.Results： All patients underwent successful closed reduction.The average traction weight was 28 kg（14-49 kg） and average traction time was 58 minutes（20-140 min）.No neurological deterioration or abnormal vital signs were found.The neurological function was improved to different extent.Conclusion： The early and gradually high weight skull traction to treat lower cervical spine fracture-dislocation with locked-facet is safe and effective.It can create good conditions for the recovery of spinal cord injury and the next surgical treatment.