一期前后路手术治疗颈椎骨折脱位并四肢瘫

One stage combined anterior and posterior approach surgery for cervical fracture or dislocation with quadriplegia

目的探讨一期前后路手术治疗颈椎骨折脱位并四肢瘫的意义。方法回顾性分析23例颈椎骨折脱位并四肢瘫患者手术治疗的临床资料。结果 23例患者随访0～12个月,平均(5.8±3.6)个月。4例患者死亡,19例患者存活,脊髓功能ASIA评分提高0～1级。术前ASIA分级为A级9例,术后ASIA评分提高为B级2例,无提高3例,死亡4例;术前ASIA分级为B级14例,术后ASIA评分提高为C级6例,无提高8例。4例死亡病例均为单纯前路减压手术:1例术后呼吸、心搏骤停死亡,2例因自主呼吸微弱出院后在家中死亡,1例死于并发肺部感染。8例ASIA分级提高一个级别的均为一期前后路减压手术。结论一期前后路颈椎管减压植骨内固定或并硬膜下减压是治疗此类患者有价值的方法。

Objective To explore the significance of one stage combined anterior and posterior approach surgery for cervical fracture or dislocation with quadriplegia. Methods The clinical data of 23 cases of cervical fracture or dislocation with quadriplegia who treated by surgery were retrospectively analyzed. Results 23 patients were followed up for 0 to 12 months, （ mean 5.8 ＋ 3.6） months. 4 patients died, 19 patients survive, according to Amerrican Spinal Injury Association （ASIA） grades, the spinal cord function of these patients were increased 0 - 1 grades. The spinal cord function was ASIA grade A in 9 cases before operation, 2 cases raised to B, 3 cases still at A, 4 cases died. The spinal cord function was ASIA grade B in 14 cases before operation, 6 cases raised to C, 8 cases still at B. 4 dead cases all were treated by operation of pure anterior decompression ： 1 case died because of breath and cardiac arrest after operation, 2 cases breathing became faint and died at home after leaving hospital, 1 case died because of combining pulmonary infection. 8 case of ASIA grade raised 1 level was treated by one stage combined anterior and posterior approach surgery. Conclusion Cervical decompression and bone grafting with internal fixation or subdural decompression in one stage combined anterior posterior approach surgery is essential method to such patients.