无脊髓损伤的单节段下颈椎骨折脱位的临床治疗疗效观察

目的探讨无脊髓损伤的单节段下颈椎骨折脱位的临床治疗策略及疗效观察。方法选择近4年来17例曾诊断为无脊髓损伤的单节段下颈椎骨折脱位患者17例为观察对象,根据患者受伤机制、致伤力分级、辅助检查和临床症状选择治疗方式,其中非手术治疗4例,手术治疗13例,观察治疗前后及术后1年的临床效果。结果保守治疗的4例患者中,有共2例治疗效果良好,骨折愈合差的有1例、关节突脱位复位后颈椎稳定性差的有1例,但均未出现脊髓受损伤的情况。手术治疗的13例患者中,术后当日所有患者均有不同程度的症状改善,治疗效果良好的有7例,出现暂时性吞咽困难的有1例、暂时性声音嘶哑的有2例,供骨区疼痛的有3例。术后6个月随访的患者颈椎的稳定性重建效果均达到良好。所有病例患者无脊髓神经受损或加重,无食管瘘及颈部血肿等并发症发生。结论根据无脊髓损伤颈椎骨折脱位患者的致伤力能量、受伤机制、影像学表现及临床症状的不同,有针对性地选择合理的治疗方法,可以获得良好的临床疗效。对于无脊髓损伤的稳定性单节段下颈椎骨折脱位应行坚持牵引、制动、复位、固定的原则进行治疗;手术治疗中前路手术除了可以达到减压及恢复颈椎间高度和生理曲度外,更重要的是可重建颈椎即刻的稳定性,对防止继发性脊髓损伤有非常重要的作用。

Objective To explore without spinal cord injury of the cervical spine fracture dislocation clinical treatment strategies and curative effect observation. Methods choose our nearly four years have no diagnosis and treatment of spinal cord injury patients with cervical spine fracture dislocation of the 34 patients, according to patients with the mechanism of injury, the injury force classification, assistant examination and clinical symptoms choice treatment, including 11 cases non-operative therapy, surgical treatment in 23 cases, observed before and after treatment and postoperative 1 year. Results The conservative treatment of 11 patients, there are a total of 5 cases of treatment effect is good, the fracture healing difference of 3 cases, joint process dislocation reset after cervical instability of 3 cases, but all did not appear the spinal cord injury. The surgical treatment of 23 patients, postoperative day all of these cases have different degrees of improvement of symptoms, treatment effect good have 15 cases, the transient of dysphagia in 2 cases, temporary cracked in 2 cases, for bone pain area 3 cases. After 6 months follow-up of patients with cervical stability reconstruction effect achieved good. All the cases without spinal nerve damage or aggravate, no esophageal fistula and neck complications, suchas thehematoma. Conclusion According to the injury of cervical fracture dislocation patients without injury force energy, mechanism of injury,imaging manifestations and clinical symptoms of different spinal cord, targeted therapies for selection of a reasonable, can achieve good clinical efficacy. For the traction, braking, should be reset, a fixed principle of treatment of fracture and dislocation without spinal cord injury of the stability of single segmental cervical anterior operation; operation treatment can achieve the relief and recovery of cervical intervertebral height and lordosis, more important is to reconstruct cervical instant stability, to prevent secondary spinal cord injury have a very important role.