颈椎单侧关节突交锁损伤机制与临床诊治

Clinical diagnosis and treatment and injury mechanism of unilateral locked facet of cervical spine

目的 研究颈椎单侧关节突交锁的损伤机制及临床诊治。 方法 两具新鲜成人颈椎标本 ,采用CMT 410 4型电子多功能试验机 ,分别在侧屈旋转和前屈旋转载荷下模拟颈椎小关节突交锁。并对 11例颈椎单侧关节突交锁患者的诊治情况进行分析。 结果 颈椎在侧屈 1170N、扭转 15 0N ,前屈 2 0 0 0N、扭转 12 0N的载荷下均可导致单侧小关节突交锁。但前者比后者容易发生 ,所需的暴力较小 ,伴随的损伤较轻。 11例患者中 ,误诊 2例 ,漏诊 1例。头颅牵引复位成功 4例 ,行颈后路切开复位钢丝固定融合 5例 ,前路减压融合 2例。平均随访 3 .5年 ,疗效较好。 结论 颈椎的屈曲旋转暴力是本症的损伤机制。临床上应仔细诊治 ,防止漏、误诊。诊断明确后 ,应立即行头颅牵引复位。复位失败 ,可采取切开复位、内固定融合术。

Objective To study the injury mechanism,clinical diagnosis and treatment of unilateral locked facet of the cervical spine (ULFCS). Methods ULFCS was simulated in two fresh cadaveric specimens of adult cervical spine loaded with lateral flexion-rotation and anteflexion-rotation on a CMT 4104 multifunction testing machine.The diagnosis and treatment of 11 patients with ULFCS were also analyzed. Results The experiment demonstrated that the cervical spine loaded with 1 170 N of lateral flexion, and 150 N of torsion or 2 000 N of anteflexion and 120 N of torsion experienced or sustained unilateral locked facet.The former condition produced facet lock more easily and made a less severe cervical injury than the latter. Among the 11 cases , 1 was overlooked, 2 were misdiagnosed. Four cases were reposited with skull traction, 5 with open reduction and fusion with a posterior approach,and 2 with decompression and fusion with an anterior approach.The average follow-up of 3.5 years showed all the patients had good results. Conclusions The force causing flexion-rotation of the cervical spine is the injury mechanism which brings about ULFCS.Clinical diagnosis should be careful to avoid misdiagnosis.Skull traction should be done immediately when the diagnosis is confirmed,and open reduction with internal fixing and fusion should be done when close reduction is failed.