屈曲侧弯旋转复位术治疗下颈椎脱位合并单侧小关节绞锁的疗效分析

Spinal Column and Cord Injury Flexion-lateral curvature-supination reduction for treatment of lower cervical dislocation with unilateral facet interlocking

目的探讨屈曲侧弯旋转复位联合一期前路手术治疗下颈椎脱位合并单侧小关节绞锁的疗效。方法回顾性分析2015年11月至2018年10月西安交通大学医学院附属红会医院脊柱病医院收治的32例单侧下颈椎骨折脱位患者资料。根据治疗方法不同分为2组:急诊组(采用前路屈曲侧弯旋转复位联合一期前路手术治疗)16例,男13例,女3例;年龄24~63岁。牵引组(采用头颅牵引复位联合二期前路手术治疗)16例,男12例,女4例;年龄20~64岁。比较两组患者的手术时间、术中出血量、住院时间、植骨融合率、美国脊髓损伤协会(ASIA)分级改善情况、日本骨科协会(JOA)评分。结果两组患者术前一般资料比较差异均无统计学意义(P<0.05),具有可比性。所有患者随访26~40个月。急诊组住院时间为(7.2±1.2)d,较牵引组(10.9±1.2)d短,差异有统计学意义(P<0.05)。两组患者的手术时间、出血量,以及术后24个月ASIA分级改善情况、JOA评分比较差异均无统计学意义(P>0.05),所有患者椎间隙均骨性融合。结论一期前路屈曲侧弯旋转复位手术与传统方法相比在神经功能恢复方面无明显区别,但住院时间更短。

Objective To investigate the efficacy of flexion-lateral curvature-supination reduction combined with primary anterior surgery for the treatment of lower cervical dislocation with unilateral facet inter-locking.Methods A retrospective analysis was performed in the 32 patients who had been admitted to Department of Spine Surgery,Honghui Hospital for lower cervical dislocation with unilateral facet interlocking from November 2015 to October 2018.According to their treatments,they were divided into 2 groups.In the emergency group treated by flexion-lateral curvature-supination reduction combined with primary anterior surgery,there were 13 males and 3 females,aged from 24 to 63 years.In the traction group treated by cranial traction reduction combined with secondary anterior surgery,there were 12 males and 4 females,aged from 20 to 64 years.The operation time,intraoperative blood loss,hospital stay,bone graft fusion,American Spinal Injury Association(ASIA)grade and Japanese Orthopaedic Association(JOA)score were compared between the 2 groups.Results There was no significant difference in the preoperative general data between the 2 groups,showing they were comparable(P<0.05).All patients were followed up from 26 to 40 months.The hospital stay for the emergency group[(7.2±1.2)d]was significantly shorter than that for the traction group[(10.9±1.2)d](P<0.05).There was no significant difference in the operation time,blood loss,ASIA grade or JOA score between the 2 groups(P>0.05).All patients achieved osseous fusion of intervertebral space.Conclusion Compared with traditional methods,flexion-lateral curvature-supination reduction combined with primay anterior surgery shows no significant difference in the recovery of neurological function but leads to a shorter hospital stay.