多节段颈椎损伤的后路手术治疗方法探讨

The Discussion of Posterior Routes Operation Treatment of Multilevel Cervical Spinal injury

目的评估颈后路单开门扩大椎板成形术结合侧块螺钉固定对于多节段颈椎管狭窄及创伤性颈脊髓损伤治疗的安全性及可行性。方法方便选取于该院2012年1月—2014年3月收治的22例行颈后路单开门扩大椎板成形术结合侧块螺钉固定术的多节段颈椎管狭窄及不稳定骨折并发脊髓损伤的患者进行回顾性研究,通过术后JOA评分的改善及并发症的发生评估手术效果。结果平均手术时间120 min,平均出血量445 m L,从C3-C7共有128枚侧块螺钉置入,包括C3∶22枚,C4:36枚,C5:38枚,C6:22枚,C7:10枚。平均术前JOA评分(3.26±0.64)分,所有患者平均随访16.5个月,平均术后JOA评分(8.21±1.37)分,明显高于术前水平(t=1.871,P<0.05),平均改善率(46.5±9.8)%。5例患者出现术后并发症,包括脑脊液漏、伤口延迟愈合、肺部感染及泌尿系感染。经治疗后其中1例术后1月死于呼吸功能衰竭。结论颈后路单开门扩大椎板成形术结合侧块螺钉固定对于多节段颈椎管狭窄及创伤性颈脊髓损伤的治疗是可行的,其优点包括手术创伤小,术中出血少,操作安全,对于骨折提供可靠地稳定性。

Objective To evaluate the safety and feasibility of open-door expansive laminoplasty in combination with lateral mass screw fixation for the treatment of multilevel cervical spinal stenosis and spinal cord injury in the trauma population.Methods Convenient selection this was a retrospective study of 22 patients who had multilevel cervical spinal stenosis and spinal cord injury with unstable fracture from January 2012 to March 2014 in our hospital. An open-door expansive posterior laminoplasty combined with lateral mass screw fixation was performed under persistent intraoperative skull traction. Outcome measures included postoperative improvement in Japanese Orthopedic Association（JOA） score and incidence of complications. Results The average operation time was 120 min, with an average blood loss of 445 ml. A total of 128 lateral mass screws were implanted into the cervical vertebrae between vertebral C3 and C7, including 22 into C3, 36 into C4,38 into C5, 22 into C6, and 10 into C7. The mean preoperative JOA score was（3.26 ± 0.24）points. The patients were followed for an average of 16.5 months, and the average JOA score improved to（8.21 ± 1.37）points, significantly higher than the preoperative score（t= 1.871, P〈0.05）, with an average improvement of（46.5±9.8）%. Postoperative complications in five patients included cerebrospinal fluid leakage, delayed wound healing, pulmonary infection, and urinary system infection.one died from respiratory failure 1 months postoperatively. Conclusion The open-door expansive laminoplasty combined with posterior lateral mass screw fixation is feasible for treating multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Its advantages include minimum surgical trauma, less intraoperative blood loss, and satisfactory stable supportive effect for reduction of fracture.