前路手术辅助手法复位治疗下颈椎脱位合并关节突交锁

Auxiliary manipulative reduction in the treatment of subaxial cervical spine dislocation associated articular process interlocking with anterior approach

目的探讨术中辅助手法复位治疗下颈椎脱位合并关节突交锁的可行性。方法 17例下颈椎脱位合并关节突交锁患者经颅骨牵引未能复位,采用前路手术切除损伤椎间盘减压,持续牵引手法复位,复位成功后行前路融合内固定。结果 17例均在术中辅以手法复位成功。手术时间70~130min,出血量50~110ml,未输血。术后无神经症状加重,术后1~2周内神经功能Frankel分级:除2例A级无变化外,其余均有1~2级改善。17例均获得随访,时间4~13个月。随访X线片提示椎体间高度及生理弧度恢复良好,植骨均在3~6个月内融合,未出现内固定松动、断裂等情况。结论 经前路手术辅助手法复位治疗下颈椎脱位合并关节突交锁安全、有效。

Objective To investigate the clinical feasibility of auxiliary manipulative reduction during operation in the treatment of subaxial cervical spine dislocation associated articular process interlocking. Methods Seventeen patients suffered from lower cervical dislocation combined with interlock of articular process who failed to cranial traction reduction.The injured intervertebral disc was removed by anterior surgery,and decompression and continued traction for manual reduction were performed.After successful reduction, anterior fusion and internal fixation were performed. Results All the 17 cases were completely reduced by auxiliary manipulative reduction during operation.The operation time was from 70 min to 130 min, intraoperative blood loss volume was from 50 ml to 110 ml and no case received blood transfusion. After operation, nervous symptoms were not aggravated, and within 1~2 weeks after operation, the neurological function scale of all patients (except A grade of 2 cases without change) was upgraded by 1~2 levels based on the improved Frankel Grade. All 17 patients were followed up from 4 months to 13 months. X-ray films displayed interbody height and physio-radian recovered well, interbody bone graft fused within 3 months to 6 months, and no looseness or breakage was found in the internal fixation system for all. Conclusions Auxiliary manipulative reduction during anterior approach of cervical fixation is a safe and effective treatment method for subaxial cervical spine dislocation associated processus condyloideus mandibulae interlocking.