前后路联合手术固定治疗严重下颈椎骨折脱位疗效观察

Curative effect of combined anterior and posterior approaches in the treatment of severe fractures and dislocations of the lower cervical spine

目的比较单纯前路手术与前后路联合手术治疗严重下颈椎骨折脱位患者的临床效果。方法回顾性分析海南省人民医院脊柱外科2010年2月至2016年2月收治的89例严重下颈椎骨折脱位患者的临床资料,其中46例给予单纯前路手术的患者作为对照组,43例给予前后路联合手术治疗的患者作为观察组。分别于术前及术后6个月,利用视觉模拟评分量表(VAS)、颈椎残障功能量表(NDI)及日本骨科协会评估治疗分数(JOA)对两组患者进行评估,并进行统计分析。结果术后6个月,对照组和观察组的VAS评分分别为(1.85±0.56)分和(1.72±0.36)分,均明显低于术前的(4.86±1.05)分和(4.85±1.02)分,差异均有统计学意义(P<0.05);术后6个月,对照组和观察组的NDI评分分别为(26.31±6.10)分和(17.26±5.37)分,均明显低于术前的(51.33±16.25)分和(52.03±15.24)分,差异有统计学意义(P<0.05);术后对照组和观察组的JOA评分分别为(11.55±1.65)分和(12.82±2.33)分,均明显高于术前的(6.39±1.02)分和(6.02±1.15)分,差异有统计学意义(P<0.05)。且术后6个月进行组间比较,观察组的NDI评分和JOA评分均明显优于对照组,差异均具有统计学意义(P<0.05);观察组JOA评分改善率为(62.12±9.54)%,明显高于对照组的(49.31±8.81)%,差异有统计学意义(P<0.05);观察组5例出现肺部感染,1例出现切口感染,未出现褥疮,并发症发生率观察组为13.95%,明显低于对照组的28.56%,差异有统计学意义(P<0.05)。结论严重下颈椎骨折脱位患者实施前后路联合手术内固定治疗效果确切,术后并发症少,值得临床推广应用。

Objective To compare the clinical results of simple anterior approach and combined anterior and posterior approaches in the treatment of severe fractures and dislocations of the lower cervical spine. Methods The clinical data of 89 patients with severe fractures and dislocations of the lower cervical spine, who admitted to Department of Spine Surgery in Hainan General Hospital from February 2010 to February 2016, were retrospectively analyzed.Theses patients were divided into the control group（46 cases） treated with anterior surgery and the observation group（43 cases） treated with anterior and posterior operation. Visual analogue scale score（VAS）, neck disability index（NDI）and Japanese Orthopedic Association score（JOA） were used to evaluate and analyze function recovery before surgery and six months after surgery respectively. Results Six months after surgery, the VAS scores in the control group and the observation group were respectively（1.85±0.56） and（1.72±0.36）, which were significantly lower than corresponding（4.86±1.05） and（4.85±1.02） before surgery in the two groups（P〈0.05）; the NDI scores in the control group and the observation group at the time of 6 months after surgery were（26.31±6.10） and（17.26±5.37）, respectively, which were significantly lower than corresponding（51.33 ± 16.25） and（52.03 ± 15.24） before surgery in the two groups（P〈0.05）; the JOA scores in the control group and the observation group were（11.55±1.65） and（12.82±2.33）, respectively, which were significantly higher than corresponding（6.39±1.02） and（6.02±1.15） before surgery in the two groups（P〈0.05）. The statistical comparison between the two groups 6 months after the operation showed that the NDI and JOA scores of the observation group were significantly better than those of the control group（P〈0.05）. The improvement rate of JOA score in the observation group was（62.12±9.54）%, which was significantly higher than（49.31±8.81）% in the control group（P〈0.05）. There were 5 cases of pulmonary infection, 1 case of incision infection, and no bedsore in the observation group,and the incidence of complications was 13.95% in the observation group, which was significantly lower than 28.56% in the control group（P〈0.05）. Conclusion The combined anterior and posterior approaches have the definite therapeutic effect and less complications in the treatment of the patients with severe fractures and dislocations of the lower cervical spine, which is worthy of being promoted in clinical application.