大重量颅骨牵引复位下颈椎小关节突脱位的机理

Closed Reduction of Lower Cervical Spine Dislocation with High Weight Skull Traction

目的 探讨大重量颅骨牵引复位下颈椎小关节突脱位的可行性及临床效果。方法 本组 6 4例 ,男 4 8例 ,女 16例 ,年龄 18～ 5 2岁 ,平均 31岁。单侧小关节突脱位 19例 ,双侧小关节突脱位 4 5例。采用Gardner颅骨牵引在X线透视监视下行闭合复位 ,牵引重量从 4 5kg始 ,每间隔 15～ 30min增加 2 5～ 4 5kg ,至复位成功为止。结果 6 4例中 ,6 0例复位成功 ,4例不成功 ,成功率为 93%。复位牵引重量为 18～ 4 0 5kg,平均 2 7 5kg。不全瘫患者均有不同程度恢复 ,7例神经功能正常者复位后均无损伤 ,无一例出现神经功能恶化。 4例不成功者中 ,1例系呼吸困难 ,1例系关节突骨折 ,1例系陈旧性脱位 ,1例因不能耐受大重量颅骨牵引而终止复位。结论 大重量颅骨牵引复位可显著提高复位成功率 。

Objective To elucidate the availability and clinical result about closed reduction of lower cervical spine dislocation with high weight.Methods There were 64 cases,48 male and 16 female.The average age was 31 years(18～52).Nineteen cases were unilateral locked facet dislocation and 45 were bilateral facet locked facet dislocation.All cases underwent closed reduction using Gardner tongs traction under fluoroscopy control.Reduction began with application of 4 5 kg of weight Traction weight was increased in 2 5 to 4 5 kg increments every 15 to 30 minutes until a reduction was obtained.Results Of 64 cases,60 underwent successful closed reduction while four failed.The successful rate was 93%.The traction weight was 18 to 40 5 kg with average 27 5 kg in successful group.All cases with partial neurological deficit showed improvement.Seven cases without spine cord injury had no neurological deficit after closed reduction.There was no neurological deterioration in any cases.Of four unsuccessful cases,one had dyspnea,one had facet fracture,one had old dislocation and other could not tolerate the high weight skull traction.Conclusion High weight skull traction could produce the greatest success rate.It rarely causes and increase in neurological deficit.