后路减压固定治疗伴椎间盘突出的下颈椎骨折脱位

Posterior decompression with cervical pedicle screw system for lower cervical fractures and dislocation with disc herniation

目的探讨经后路减压复位椎弓根螺钉固定治疗伴椎间盘突出的下颈椎骨折脱位的疗效。方法对2009年6月至2012年9月采用经后路减压复位椎弓根螺钉固定治疗伴椎间盘突出的下颈椎骨折脱位18例病例进行回顾性分析。结果所有手术均顺利完成,共置入椎弓根螺钉88枚,平均手术时间为2.7 h,平均出血量为400 mL。所有患者均未因神经功能恶化或椎间盘突出而需要再次行前路手术。18例患者术后平均随访15个月。复查X线片、CT片示骨折脱位复位良好,椎间隙高度及颈椎生理弧度得到恢复。末次随访时,除10例Frankel A级患者以外,其余患者Frankel分级提高1-2级。结论经后路减压复位椎弓根螺钉固定可适用于伴椎间盘突出的下颈椎骨折脱位,后路手术有利于复位,椎弓根螺钉技术具有良好的生物力学稳定性,能有效地恢复和维持颈椎的序列,同时避免了前路手术。

Objective To evaluate the effectiveness of posterior decompression with cervical pedicle screw system for cervical fracture-dislocations with traumatic disc herniation.Methods From June 2009 to September 2012,a retrospective analysis was done on 18 patients with cervical fracture-dislocations and traumatic disc herniation subjec to posterior decompression with cervical pedicle screw system.Results 18 cases were successfully operated and 88 screws were exactly implanted in the cervical pedicle.The average operative time was 2.7 h. The average blood loss during the operation was 400 mL.All patients had no neurological deterioration or protrusion of the intervertebral disc,and no anterior re-operation was done.The average follow-up period was 15 months.All patients had satisfactory reduction as well as disc height and cervical lordosis restored.At final follow-up,all patients obtained improvement of neurological function by 1 Frankel grade,except 10 patients with Frankel A.Conclusion Posterior decompression with cervical pedicle screw system was suitable for cervical fracture-dislocations with traumatic disc herniation.The posterior approach is beneficial for reduction and biomechanical stability.The internal fixation of pedicle screws can effectively restore and maintain cervical lordosis,and anterior surgery can be avoided.