单纯前路手术治疗下颈椎骨折脱位的临床分析

Clinical study of pure anterior-approach operation for treating lower cervical spine fracture and dislocation

目的探讨下颈椎骨折脱位单纯前路手术治疗的效果。方法回顾分析该院2004年1月至2012年1月行单纯前路植骨钛板内固定手术治疗,并获得1年以上随访的33例下颈椎骨折脱位患者临床资料。其中26例单间隙融合,7例椎体次全切除,均行自体髂骨植骨。所有患者术前均行颈椎X线片、CT及MR了解骨折脱位情况,术后摄颈椎X线片了解植骨融合状况,颈椎生理前凸恢复保持情况和内固定稳定性。以美国脊柱损伤协会（ASIA）残损分级评价神经功能恢复情况。结果所有患者随访1.0~4.5年（平均1.8年）,术后ASIA残损分级平均提高1.6级,固定椎保持稳定,颈椎生理前凸得以保持,无明显植骨不愈合表现。结论单纯前路手术对治疗下颈椎骨折脱位有较好的效果,严格掌握适应证,充分恢复伤椎高度及颈椎生理前凸,牢固的内固定等是手术治疗成功的关键。

Objective To explore the effect of the pure anterior-approach operation for treating lower cervical spine fracture and dislocation.Methods Follow-ups were conducted in 33 successive patients who had been diagnosed as lower cervical spine fracture and dislocations,and undergone anterior-approach operation from January 2004 to January 2012.The data were analyzed retrospectively.A total of 26 cases had one segment fusion and 7 cases had subtotal vertebrectomy and fusion among the patients,and all the patients had auto-bone-graft.Preoperative plain Xray,CT and MRI were done to check the fracture and dislocation,and postoperative X-ray was used to evaluate the fusion,the restitution of cervical lordosis,and the stability of intro-fixation.The clinical improvement was judged by ASIA score system.Results The average period of follow-up was 1.8（1.0to 4.5）years.All the patients had substantial clinical improvement.Average improvement of the grade of ASIA was 1.8.No deterioration,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 the patients.Conclusion Pure anterior-approach operation had good effect on lower cervical spine fracture and dislocation,but its indication should be strictly followed,fully recovering injured vertebral height and cervical lordosis,stable internal fixation is a key to the success of surgery