前路椎间撬拨结合颅骨牵引复位固定术治疗下颈椎小关节绞锁的临床观察

Effect of combination of reduction technique(anterior intervertebral leverage and skull traction)and instrumented fusion for locking facet in lower cervical spine

目的探讨前路椎间撬拨结合颅骨牵引复位固定术治疗下颈椎小关节绞锁的临床效果和安全性。方法选取北京市房山区良乡医院2009年4月至2018年11月收治的22例下颈椎小关节绞锁患者,年龄25~64岁,平均(42.4±13.7)岁。单侧绞锁9例,双侧绞锁13例。损伤节段:C3~C42例,C4~C53例,C5~C610例,C6~C77例。合并损伤:创伤性椎间盘突出3例,椎体骨折4例,关节突关节或椎板骨折5例,头面或颅脑损伤4例。伤后美国脊柱损伤协会(American Spinal Cord Injury Association,ASIA)分级:B级1例,C级4例,D级11例,E级6例。伤后1~15 d行手术治疗,平均(6.2±4.3)d。全麻下行前路椎间减压,利用融合器试模在椎间撬拨结合颅骨牵引复位小关节绞锁,然后行椎间植骨融合内固定术。记录手术时长、术中出血量、复位成功率、术后ASIA分级变化、椎间融合情况、手术并发症情况。结果手术时间65~176 min,平均(106±25)min;术中出血量30~310 ml,平均(89±58)ml;复位成功率100%;术后随访13~26个月,平均17个月。术后ASIA分级均有提高,神经功能不同程度恢复,未出现神经损伤加重。以Bridwell标准评价,融合率为95.5%。1例发生一过性喉返神经损伤,无二次手术病例。结论前路椎间撬拨结合颅骨牵引复位固定术治疗下颈椎小关节绞锁成功率高、创伤小、融合率高,短、中期随访疗效好,是一种安全有效的治疗方法。

Objectives To explore the clinical efficacy and safety of combination of reduction technique(anterior intervertebral leverage and skull traction)and instrumented fusion for locking facet in lower cervical spine.Methods The clinical data of 22 patients from April 2009 to November 2018 with locking facet in lower cervical spine were analyzed retrospectively.There were 19 males and three females,with an average age of(42.4±13.7)years(25~64).The interlocking was unilateral in nine cases and bilateral in 13 cases.The injury segments were C3~4 in two cases,C4~5 in three cases,C5~6 in 10 cases,C6~7 in seven cases.There were three cases with traumatic disc herniation,four cases with vertebra fracture,five cases with lamina or articular facet fracture,four with craniocerebral or/and facial injury.American Spinal Injury Association(ASIA)score was B in one cases,C in four cases,D in 11 cases,E in six cases.The preoperative time was(6.2±4.3)days(1~15 days).Under general anesthesia and skull traction,the injured disc was completely removed through a standard Smith-Robinson approach.A spreader was put in intervertebral space and levered the vertebral body upward combined with skull traction in flexion position to achieve reduction.Then intervertebral fusion and instrument fixation were performed.The operation time,intraoperative blood loss,success rate of reduction,complications,the AISA grade and fusion rate at the last follow-up were analyzed.Results Complete reduction was achieved in all patients.The mean operation time was(106±25)min(65~176 min)and the mean blood loss was(89±58)ml(30~310 ml).The follow-up ranged from 13 to 26 months(17 months in average).ASIA grade was increased with no aggravation after operation.Transient injury of recurrent laryngeal nerve in one case.Judged by Bridwell criterion,the interbody fusion rate was 95.5%,only one case wasⅢgrade but no complain.No second operation was required.Conclusions Anterior intervertebral leverage combined with skull traction is an effective and safe reduction technique for locking facet in lower cervical spine,and anterior instrumented fusion can provide satisfactory short and medium term efficacy.