一期经前后路脊柱重建治疗下颈椎骨折脱位并关节突交锁

One-stage Spinal Reconstruction by Anterior and Posterior Approaches for Lower Cervical Fractures and Dislocations Combined with Locked-facet

目的 探讨一期经前后路脊柱重建治疗下颈椎骨折脱位并关节突交锁的临床疗效。方法 回顾性分析2018年1月至2020年12月我院收治的15例下颈椎骨折脱位并关节突交锁病人的临床资料,均采用一期经前后脊柱重建的手术方式治疗。采用日本骨科协会(JOA)评分、颈椎功能障碍指数(NDI)评价术后恢复情况,采用美国脊柱损伤协会(American Spinal Injury Association,ASIA)神经功能分级评价脊髓神经改善情况,通过影像学检查(X线/CT/MRI)评价椎体复位及邻近节段椎间盘退变情况。结果 本组病人术后随访6~12个月。术后及末次随访的JOA评分[(14.01±1.22)分、(15.11±1.08)分],NDI(20.1%±1.2%、15.1%±1.8%),椎体间位移[均为(1.52±0.04)mm]和半脱位伴成角度数(2.03°±0.08°、2.04°±0.07°)均较术前显著改善,差异有统计学意义(P<0.05)。术后及末次随访ASIA分级均有不同程度改善。末次随访时,手术节段上、下位邻近节段椎间盘均有一定程度退变,且上位较下位严重,差异有统计学意义(P<0.05)。结论 一期经前后路脊柱重建治疗下颈椎骨折脱位并关节突交锁,复位效果好,稳定性强,脊髓神经功能得到改善,但远期存在邻近节段椎间盘退变风险。

Objective To investigate the clinical efficacy of one-stage spinal reconstruction by anterior and posterior approaches for lower cervical fractures and dislocations combined with locked-facet.Methods The clinical data of 15 patients with lower cervical fractures and dislocations combined with lockedfacet treated in our hospital from January 2018 to December 2020 were retrospectively analyzed. They all received one-stage spinal reconstruction by anterior and posterior approaches. The postoperative recovery was evaluated by Japanese Orthopaedic Association(JOA) score and neck disability index(NDI), the improvement of spinal cord nerve was evaluated by the neurological function classification of American Spinal Injury Association(ASIA), and the vertebral reduction and the degeneration of adjacent intervertebral discs were evaluated by imaging(X-ray/CT/MRI). Results All patients were followed up for 6-12 months. After operation and at the last follow-up, JOA(14.01 ± 1.22 and 15.11 ± 1.08), NDI(20.1% ± 1.2% and 15.1% ± 1.8%),intervertebral displacement[both(1.52 ± 0.04) mm], subluxation with angulation(2.03° ± 0.08° and 2.04° ±0.07°) were significantly improved as compared with those before operation(P<0.05). After the operation and at the last follow-up, the ASIA grade was improved to varying degrees. At the last follow-up, the upper and lower segments of the adjacent intervertebral disc degenerated to a certain degree, and the upper level was more serious than the lower level(P<0.05). Conclusion In the treatment of lower cervical fracture dislocation and joint process interlocking in the first anterior and posterior spinal reconstruction, there was good reduction effect, strong stability and improved spinal nerve function, but there was the risk of intervertebral disc degeneration in adjacent segments in the long term.