颈前路撑开螺钉提拉复位与颈前路常规复位治疗创伤性颈椎骨折脱位的疗效比较

Comparison of effects of anterior cervical reduction by distraction and screw pulling over conventional anterior cervical reduction in the treatment of traumatic cervical spine fracture and dislocation

目的对比颈前路撑开螺钉提拉复位与颈前路常规复位治疗创伤性颈椎骨折脱位的临床疗效。方法选择86例创伤性颈椎骨折脱位患者,将颈前路撑开螺钉提拉复位治疗的46例设为观察组,颈前路常规撬拨复位治疗的40例为对照组。比较两组患者手术情况及疗效,并记录并发症发生情况。结果观察组手术时间显著低于对照组,差异具有统计学意义(P<0.05);两组住院时间、术中出血量差异无统计学意义(P>0.05);两组术后Frankel神经功能分级均显著改善,但组间差异无统计学意义(P>0.05);两组治疗7d、3月、末次随访JOA评分均显著高于术前,VAS评分显著低于术前,但组间差异无统计学意义(P>0.05);观察组并发症总发生率为8.70%,对照组为20.00%,观察组显著低于对照组(P<0.05)。结论颈前路撑开螺钉提拉复位与常规撬拨复位均能显著降低疼痛症状,提升颈椎活动及神经功能,具有相似的近远期疗效,但前者手术操作更为简便,并发症控制效果更优。

Objective To compare the effect of anterior cervical reduction by distraction andscrew pulling over conventional anterior cervical reduction in the treatment of traumatic cervical spinefracture and dislocation. Methods The clinical data of 86 patients with traumatic cervical fractureand dislocation treated in our hospital from June 2012 to January 2017 were selected and the clinicaldata were retrospectively analyzed. Forty patients in the control group received the anterior cervicalreduction by poking reduction, while 46 patients in the observation group received the anterior cervicalreduction by distraction and screw pulling. All patients were followed up for 12 months. The operativetime, length of hospital stay and intraoperative blood loss were recorded. Frankel grading, cervicalspine function score （JOA）, pain score （VAS） and complications were recorded and compared betweenthe two groups. Results The operation time of the observation group was shorter than that of thecontrol group （P〈0.05）. No difference was found in the hospitalization time and intraoperative bloodloss between the two groups （P〉0.05）. The Frankel grading was ameliorated after operation in both twogroups, with no statistically significant difference （P〉0.05）. At 7d, 3 months after treatment and at thelast follow-up, the JOA scores were increased, and the VAS scores were decreased in both two groups,with no statistically significant differences between two groups at different time points （P〉0.05）. Thetotal incidence rate of complications in the observation group was significantly lower than that in thecontrol group （8.70% vs 20.00%, P〈0.05）. Conclusion Both anterior cervical reduction by distraction and screw pulling and by conventional anterior cervical reduction can alleviate the pain symptoms,ameliorate the cervical vertebra activity and nerve function for patients with traumatic cervical fractureand dislocation, which have the similar short -term effect, however, the former has easier operationprocedure and less complications.