严重下颈椎骨折脱位的术式选择与疗效分析

Choice on the surgical treatment of severe fracture and dislocation of the lower cerical spine and its curative effect

目的探讨治疗严重下颈椎骨折脱位的术式选择和手术疗效。方法 2004年9月~2010年7月笔者对83例严重下颈椎骨折脱位患者应用前路、后路和一期后-前路或是前-后-前联合入路（后路撬拨复位、植骨融合内固定术＋前路颈椎损伤节段椎间盘切除或椎体次全切＋钛板（钛网）植骨融合内固定术）治疗。术后对比评估的方法,使用测量Cobb角、椎体水平移位和Frankel评分表评价脊髓功能恢复与脊柱损伤重建稳定性等情况。结果 80例患者获得有效随访,在手术参数、术后力学参数方面对其进行比较,联合入路组手术时间和出血量均较单纯前路或后路组长,神经学方面,7例术前Frankel分级A级无恢复外,其余患者均有不同程度恢复,脊髓功能平均提高1.1级。术后4~6个月摄片融合节段均获得骨性融合。结论应用一期联合手术入路在复杂下颈椎骨折脱位方面较单纯前路或后路手术具备更宽的适证,需要掌握严格手术指征和根据病情制订个性化治疗方案。

Objective To investigate the choice on the surgical treatment and the clinical effect of severe fracture and dislocation of lower cervical spine.Methods 83 patients with severe fracture and dislocation of lower cervical spine were treated with anterior-posterior path,one stage posterior-anterior or anterior-posterior-anterior operation with internal fixation（posterior percutaneous reduction by leverage,bone graft fusion with internal fixation＋subtotal vertebrectomy grafting＋ titanium plate fixation） in our hospital from September 2004 to July 2010.The function of the spinal cord was evaluated by Cobb angle,vertebral body level shift,and Frankel score.Results 80 cases were followed-up,except 7 cases of the spinal cord function frankel a gained no recovery,the others improved by 1.1 grades in average,and the injured segments were all got fused from 4 to 6 months after operation.They were compared in operation parameter,mechanics parameter after operation.The operation time and blood volume of approach combination group was longer than simple anterior or posterior group.The patients were recovered in neurology.Conclusion One-stage combined anterior-posterior decompression and internal fixation for the severe fracture and dislocation of lower cervical spine that on the premise of mastering the indication and establish emergency individuation treatment protocols on the basis of traumatic condition is a reliable therapeutic method which can achieve the immediate stability of biomechanics and neurology.