一期后前路手术治疗下颈椎骨折脱位伴关节突绞锁

Treatment of lower cervical fracture dislocation and articular process interlocking by one-stage anteroposterior approach

目的：探讨一期后前联合入路治疗下颈椎骨折脱位伴关节突绞锁的临床疗效。方法2008年9月～2012年5月，笔者手术治疗32例成人颈椎骨折脱位伴关节突绞锁，其中单侧小关节脱位23例，双侧小关节脱位9例。术前神经功能ASIA分级： A级5例，B级12例，C级11例，D级3例，E级1例。均采用一期后路小关节撬拨复位或关节突切除复位、前路植骨融合内固定术。术后定期随访，通过影像学检查了解节段稳定性、植骨融合情况，比较患者手术前后ASIA分级变化，进行疗效评价。结果32例随访10～24个月，平均15个月。术后影像学检查显示复位效果满意，颈椎椎间高度及生理曲度维持良好，植骨全部融合，无钢板螺钉并发症；除术前ASIA分级A级的3例患者神经功能无恢复，其余29例神经功能均有1～2级的恢复。结论一期后前联合入路治疗下颈椎骨折脱位伴关节突绞锁可以获得满意的临床效果。

Objective To investigate the clinical effectiveness of one-stage anteroposterior approach in trea-ting lower cervical fracture dislocation and articular process interlocking .Methods From Sep.2008 to May 2012,32 adult patients with cervical fracture dislocation and articular process interlocking were enrolled in this study （23 pa-tients with unilateral facet dislocation ,9 patients with bilateral facet dislocation ） .The ASIA grading system for pre-operative neurological function indicated that there were 5 cases of grade A ,12 cases of grade B ,11 cases of grade C , 3 cases of grade D ,and 1 case of grade E . All the patients were treated with reduction and fixation through an anteri-or and posterior method .The segmental stability and bone graft fusion were evaluated through the postoperative radio -graphic examinations , the neurological status was reviewed preoperatively and postoperatively . Results All cases were followed up for a mean time of 15 months（10-24 months）.The results of decompression and reduction were sat-isfactory,the intervertebral height and lordosis were maintained normal ,bone fusion was achieved ,and no plate and screw related complications were observed .Grade 1-neurological recovery was achieved in 29 cases and no neurologi-cal recovery was obtained in the other 3 cases of grade A .Conclusion One-stage anteroposterior approach has a sat-isfactory clinical effect in treating lower cervical fracture dislocation and articular process interlocking .