大重量牵引复位前路融合内固定治疗陈旧性下颈椎脱位

Treatment of old dislocation of lower cervical spine by reduction with high weight traction and internal fixation of anterior fusion

目的探讨大重量牵引复位前路融合内固定治疗陈旧性下颈椎脱位的价值和注意事项。方法本组8例,男5例,女3例,受伤至入院时间3周～6个月,平均2.5个月,入院后行颅骨牵引,逐渐增加重量,难以复位者行小关节突切除,复位后行前路植骨融合,钢板内固定术。结果8例患者均获较好的复位,其中6例获完全复位;复位牵引重量10～18kg,平均13.5kg;6例获得随访,平均随访14.5个月,按Frankel分级,除1例A级患者无恢复外,其余5例均有恢复,分别改善1或2级;所有患者均获骨性融合。结论采用大重量颅骨牵引,难以复位者辅以小关节突切除,复位后行前路植骨融合,钢板内固定术治疗陈旧性下颈椎脱位,疗效满意。

Objective To study the value of and points for attention in reduction with high weight traction and internal fixation of anterior fusion in treatment of old dislocation of lower cervical spine. Methods There were 8 cases of old dislocation of lower cervical spine, 5 males and 3 females. Their durati on from injury to admission to our hospital ranged from 3 weeks to 6 months (ave raged 2.5 months). All cases underwent closed reduction by skull traction with w eight increased gradually. Facetectomy was performed if it was difficult to achi eve reduction. Anterior graft and fusion with plate fixation was applied after r eduction. Results All cases obtained reduction successfully and complete reducti on was achieved in 6 cases. The final weight of traction was 10 to 18 kg with an average of 13.5kg. 6 cases were followed up for an average of 14.5 months. The neurological condition had improvement of one or two Frankel scales in 5 cases, but none in one patient with Frankel A injury. All cases obtained bone fusion. C onclusions To treat old dislocation of lower cervical spine, satisfying results can be achieved by high weight skull traction and anterior fusion with plate fix ation after reduction. Facetectomy is helpful when it is difficult to achieve re duction.