前路减压经口咽寰枢椎前路复位钢板系统复位器辅助下治疗下颈椎骨折脱位合并关节突绞锁

Treatment of lower cervical fracture dislocation complicated with facet interlocking by anterior de- compression and a repositor for transoral atlantoaxial reduction plating

【摘要】目的介绍前路减版经口咽寰枢椎前路复位钢板系统（TARP）复位器辅助下治疗下颈悱骨折脱位合并关节突绞锁的方法。方法对2010年1月至2012年10月收治的12例下颈椎骨折脱位合并关节突绞锁患枵的临床资料进行回顾性研究，男9例，女3例；年龄25～46岁，平均30．6岁；损伤部位：C4.5 1例，C5.6 6例，C6.7 5例；根据Allen分类，所有患抒均为牵拉屈曲型，其中单侧绞锁7例，舣侧绞锁5例：脊髓损伤按Frankel分级：A级2例，B级2例，C级3例，D级4例，E级1例、均采刚单纯前路手术复位、减J土TARP复位器辅助下内固定治疗。对术时、术后冲经功能、影像学改蒋和并发症发生情况进行分析，，结果伤口均Ⅰ期愈合，无感染发生，术后来出现神经痛状加重。所有患者术后获6～36个月（平均17个月）随访．．尤发生内匮J定松动、移位或断裂。植骨均在术后6个月内获骨性融合。随访时脊髓损伤Frankel分级：A级1例，B级2例，C级2例，D级2例，E级5例。结论住TARP复他器的辅助下，单纯前路手术能有效治疗下颈椎骨折脱位并关节突绞锁，是一种安全、简便、有效的治疗方法．．

Objective To introduce a novel surgical treaLment of lower cervical fracture dislocation complicated with thcet interlocking by simple anterior decompression and a repositor for transoral atlantoaxial reduction plating （TAtS.P） . Methods We mated 12 palients with lower cervical fi＇ac.ture disloeatiml complicated with facet interlocking between January 2010 through October 2012. They were 9 men and 3 women, aged from 25 to 46 years （average, 30.6 years）. The injury levels： C4,5 in one, C5.6 in 6 and （26. 7 in 5 cases. Fly Allen classification, all patients I）chmged to the tractive flexhm type, with 7 eases of uni- lateral interhmking and 5 cases of bilateral interlocking. According to the Frankel grading, the spinal injury was grade A in 2. grade B in 2, grade C in 3, grade D in 4 and grade E in one. All the patients were treated operatively by simple anterior reduction, decompression and internal fixation with the help of a TARP resitor. We compared the pre- and post-operative neural functions and analyzed imaging imprm＇ements and com- plications. Results All the 12 eases achieved reduction after operation. All incisions healed primarily without infection or worsening neural symptoms. The follow-ups ranged from 6 to 36 months, averaging 17 months. No implant loosening, displacement or breakage occurred. All bone grafts got bony fusion within 6 months after operation. The follow-up Frankel grading showed grade A in one, grade B in 2, grade C in 2, grade D in 2 and grade E in 5, with improvement of one to 2 grades for all the palients. Conclusion The simple anterior deeomprcssion and a TARP repositor is a safe, simple and effective surgical treatment for lower cervical fraclure dislocalitm complicated with facet interlocking.