单侧小关节交锁的下颈椎骨折脱位的手术疗效

Surgical effect of lower cervical fracture dislocation with unilateral process interlocking

目的探讨单侧小关节交锁的下颈椎骨折脱位的手术适应证和疗效。方法对23例伴单侧小关节交锁的下颈椎骨折脱位患者分别采用前方入路(8例)、后方入路(10例)和后-前联合入路(5例)进行复位减压植骨融合内固定手术治疗,比较手术前后疼痛VAS评分、Cobb角及脊髓损伤ASIA评分。结果 23例均获得随访,时间12~24个月。Cobb角:术前为15.3°±1.4°,末次随访为3.5°±0.4°,差异有统计学意义(P<0.05)。VAS评分:术前为(8.8±1.2)分,末次随访为(3.8±1.5)分,差异有统计学意义(P<0.05)。脊髓损伤ASIA运动评分:术前(45.5±6.5)分,末次随访为(65.2±5.5)分,差异有统计学意义(P<0.05)。结论前路手术可以直接处理椎间盘损伤并即刻消除颈椎不稳(术前小关节已复位);后路手术能解除小关节突交锁(椎间盘无突出)的患者,避免气管切开创口所导致的感染,同时可进行侧块或椎弓钉内固定;后-前联合入路能一期处理无法闭合复位的小关节交锁和椎间盘严重受损的患者,手术能达到坚强内固定。

Objective To investigate surgical indication and efficacy of lower cervical fracture dislocation with unilateral process interlocking via anterior or posterior,anterior-posterior approach.Methods The 23 patients of lower cervical fracture dislocation with unilateral process interlocking had undergone the operation of reduction and intern fixation via anterior approach（8 cases） or posterior approach（10 cases） or anterior-posterior approach（5 cases）.VAS and Cobb angles,ASIA scores of spinal cord injuries were compared before and after operation.Results All 23 cases were followed up for 12~24 months.Cobb angles were 15.3°±1.4° before operation,3.5° ±0.4° lastly followed after operation;VAS before operation was 8.8±1.2,3.8±1.5 at last follow-up.There were significant differences in Cobb angles and VAS before and after operation（P〈0.05）.Motor scores of ASIA before operation were 45.5±6.5,65.2±5.5 at last follow-up.The difference was statistically significant（P〈0.05）.Conclusions The patients with reduced unilateral process interlocking of lower cervical before operation can restore the instability of cervical handling injured disc through anterior approach instantly.The patients without protruding disc with irreducible unilateral process interlocking of lower cervical before operation can restore process interlocking of cervical avoiding the infection from tracheotomy through posterior approach on treatment of lateral mass screw or pedicle screw.The patients with seriously injured disc and irreducible unilateral process interlocking of lower cervical before operation can be treated on one-stage operation through posterior-anterior approach to attain the firm internal fixation.