下颈椎损伤的手术治疗

Surgical Treatment of Sub-axial Cervical Spine Injury

目的探讨SLIC评分系统在手术治疗下颈椎损伤中的指导作用。方法 2007-05/2010-05手术治疗下颈椎损伤72例,男43例,女29例,年龄20～64岁,平均36.5岁。受伤至手术时间2～30d,平均7.3 d。致伤原因包括交通伤40例,高处坠落伤23例,体育运动伤5例,暴力伤4例。损伤节段:C3 1例,C4 2例,C5 8例,C6 9例,C7 4例,C3～4 3例,C4～5 7例,C5～6 16例,C6～7 13例,C7～T1 4例,C3～51例,C4～6 2例,C6～T12例。治疗前神经功能ASIA分级:A级7例,B级36例,C级17例,D级10例,E级2例。应用SLIC评分系统,评分等于4分5例和>4分67例选择手术治疗。依据损伤形态学不同,结合DLC损伤和神经功能状况选择前路、后路或联合前后路手术治疗,随访并对不同的手术入路治疗下颈椎损伤的效果进行评价。结果随访11～35个月,平均18.3个月。72例中植骨均在6～9个月内融合,椎间高度和生理曲度维持良好。7例脊髓完全性损伤者神经功能无明显变化外,其余患者神经功能均有不同程度恢复,术后12个月ASIA分级平均改善1.2级。结论依据SLIC评分系统中损伤形态学不同、结合DLC损伤和神经功能状况选择前路、后路或联合前后路手术,治疗下颈椎损伤可取得满意的临床疗效。

Objective To explore the role of SLIC classification system in the surgical treatment of sub-axial cervical spine injury.Methods From May,2007 to May,2010,72 patients with sub-axial cervical spine injury were treated,in which 43 were males and 29 were females,with an average age of 36.5（ranging from 20 through 64） years.The causes of injury were traffic accident in 40 cases,fall in 23,sports injury in 5 and direct violence in 4 cases.Injured segments were C3 in 1 case,C4 in 2 cases,C5 in 8,C6 in 9,C7 in 4,C3-4 in 3,C4-5 in 7,C5-6 in 16,C6-7 in 13,C7-T1 in 4,C3-5 in 1,C4-6 in 2,C6-T1 in 2.By American Spinal Injury Association（ASIA） criteria,the neurologic function was graded as A in 7 cases,as B in 36,as C in 17,as D in 10 and E in 2.The 5 cases of 4 SLIC points and 67 cases of more than 4 SLIC points were performed surgical treatment.anterior approach,posterior approach,or combined anterior-posterior approach were selected according to different injury morphology.All cases were followed up to evaluate the therapeutic effects.Results The follow-up lasted for 11-35 month（average 18.3 months）.The 72 cases having surgical treatment showed good bone fusion within 6 to 9 months and good maintenance of the intervertebral height and cervical curvature.All patients with neurological injury obtained an average improvement of 1.2 ASIA grades 12 months after the surgery,except for 7 cases of spinal cord completely injury.Conclusions Sub-axial cervical spine injury be treated with different surgical treaments according to its injury morphology,DLC injury and neurological function of SLIC scores system that satisfactory outcomes can be achieved.