颈胸段脊柱损伤的临床特点及其前路手术疗效探讨

Investigation of clinical characteristics of cervicothoracic spine trauma and the effect of anterior operation of cervicothoracic spine junction

目的 探讨颈胸段脊柱脊髓损伤的临床特点及颈胸段前路减压、植骨、Orion钢板内固定术的治疗作用。 方法 2 4例颈胸段脊柱损伤患者 ,损伤部位为C6～T1;损伤类型为椎体爆裂性骨折 16例 ,椎体压缩性骨折 6例 ,单纯骨折脱位 2例。分析上述患者的临床表现 ,并分别行颈胸段前路C7、C6,7、T1或C7～T1椎体次全切除、植骨及Orion锁定型颈椎前路钢板固定术。 结果颈胸段脊柱脊髓损伤患者通常表现为C8、T1或T2 相应节段脊髓神经根症状 ,其中 8例伴有窦性心动过缓、7例出现低血压、6例出现Horner征等交感神经节刺激症状。所有患者随访 3～ 18个月 ,植骨均在 3～ 4个月内完全融合 ,其中 17例术后脊髓神经功能有不同程度改善 ,2 1例伴有交感神经节刺激症状者有所缓解 ,1例术后出现暂时性声音嘶哑。 结论 颈胸段前路减压、植骨、Orion钢板内固定术对颈胸段脊柱脊髓损伤具有较好的疗效。Orion钢板有助于植骨节段融合。

Objective To investigate the clinical characteristics of cervicothoracic spine and spinal cord trauma, and the effect of anterior decompression, bone graft and Orion plate fixation on treatment of cervical thoracic spine trauma. Methods The clinical characteristics of cervicothoracic spine and spinal cord trauma at C 6 T 1 in 24 cases were analyzed. All cases had relative cord or nerve root symptom on C 8 T 2, and some cases had sympathetic gang irritant symptom, including 8 cases with sinus bradycardia, 7 cases with hypotension and 6 cases with Horner sign. Anterior subtotal vertebraectomy at C 7,C 6,7 ,T 1 or C 7 T 1 segments, bone graft and Orion anterior cervical locking plate fixation in cervicothoracic spine were performed. The cases were followed up for 3 18 months. Results Complete fusion of bone graft occurred within 3 4 months in all cases. There were no complications of loosening and breaking of the plate and screws. Spinal cord neurological function in 17 cases improved in different degrees. The above sympathetic gang irritant symptoms were alleviated. Transient voice hoarse occurred in one case. Conclusions Anterior decompression, bone graft and Orion locking plate fixation have better effect in treatment of spine and spinal cord trauma in cervicothoracic junction, and are helpful for bone graft healing, reconstruction and stability in cervicothoracic spine.