前路手术治疗外伤性陈旧性下颈椎脱位

目的探讨前路手术治疗外伤性陈旧性下颈椎脱位疗效及可行性。方法对11例外伤所致的陈旧性下颈椎脱位患者进行前路减压椎间融合钢板内固定术，术前摄颈椎x线片，并作三维CT及颈椎MRI检查，了解骨折脱位及脊髓受压情况，术后摄颈椎x线片了解植骨融合、颈椎生理弧度恢复状况和内固定稳定性，并进行Frankel’s分级与术前比较改善程度。结果所有患者均获随访，随访期间8～39个月，平均23．4个月，术后功能Frankel’s分级均有改善，无术后神经损伤症状恶化、局部和全身并发症发生，固定节段稳定，颈椎生理性前突恢复并保持，内固定稳定，植骨愈合，无假关节形成。结论前路手术对治疗陈旧下颈椎脱位具有很好的临床疗效。严格掌握手术适应证、规范的手术操作、充分减压、牢固内固定，是手术成功的关键。

Objective To investigate the outcomes of the anterior-approach operation in treatment of lower cervical spine dislocation by a retrospective study. Methods Follow-ups were done for 11 successive patients who had been diagnosed as old lower cervical spine dislocation from February 2006 to August 2012 and undergone anterior-approach operation.All the patient had discectomy, auto-bone-graft fusion and plate-fixation. Preoperation plain X-ray, three-D CT and MRI were done to check the dislocation and compression on the spine cord, and postoperation plain X-ray to evaluate the fusion, the restitution of cervical lordosis, and the stability of intro-fixation.The clinical improvement was evaluated by Frankel＇ s grade. Results The mean period of follow-up was 26 months （ from 8 to 37months ） .All the patients had substantial clinical improvement.No deterioration, or general or local complication happened.The fused segments were stable, and the retrieved cervical lordosis remained, and no nonunion happened.The intro-fixations were stable in all. Conclusion Treatment of old cervical spine frac^e with anterior-approach operation has satisfactory results, as long as the indication are strictly followed, the cervical lordosis is restituted sufficiently, and intro-fixation are kept stable.