影响下颈椎骨折脱位在麻醉下手法复位失败的多因素分析

Analysis of related factors on the closed reduction under general anesthesia in the treatment of lower cervical fracture-dislocations

目的探讨影响下颈椎骨折脱位在麻醉下闭合复位失败的相关影响因素。方法通过回顾我科于2006年1月~2011年1月治疗下颈椎骨折脱位病例85例。分别记录患者的年龄、性别、颅骨牵引重量、颅骨牵引时间、骨折脱位节段、交锁、并发多颈椎骨折、关节突关节骨折、前纵韧带及椎间盘损伤、后方韧带复合体损伤等相关因素,观察患者麻醉下复位的情况,分析引起复位失败原因。结果影响复位失败的相关因素和顺序为关节突关节交锁;前纵韧带及椎间盘损伤;多发颈椎骨折。结论下颈椎骨折脱位伴双侧交锁是麻醉下手法复位的适应症;单侧交锁或多发颈椎骨折受伤是相对禁忌症,选择适当的病例,可以减少医源性损伤,简化手术。

Objective To explore the correlative factors on the closed reduction under general anesthesia in the treatment of lower cervical fracture-dislocations.Methods 85 cases of lower cervical fracture-dislocations from January 2006 to January 2011 were retrospectively reviewed.The correlative factors including age,sex,skull traction﹙weights/times﹚,segment of fracture-dislocation,facet locked,multi-cervical spine fracture,facet joints fracture,anterior longitudinal ligament or intervertebral disc injury,and posterior ligamentous complex﹙PLC﹚injury were put into multivariate analysis.Results Factors that might have an impact on fail of closed reduction were ranked in the likelihood sequence ： facet locked,anterior longitudinal ligament or intervertebral disc injury,and multi-cervical spine fracture.Conclusions Lower cervical fracture-dislocations with bilateral facet locked is indication of the closed reduction under general anesthesia and with unilateral facet joint locking or multi-cervical spine injury is relative contraindications.If selecting the appropriate case,we can reduce iatrogenic injury and simplify the operation.