手术治疗下颈椎骨析脱位22例报告

Surgical treatment of 22 cases of inferior cervical fracture and dislocation

目的探讨下颈椎骨折脱位手术方法的选择。方法对22例下颈椎骨折脱位按AO分型,其中B3.1型10例,B3.2型1例,C2.1型6例,C3.1型2例,C3.2型3例。常规行颅骨牵引。对经牵引复位的各型及未复位的AOB3.1型,采用前路手术减压Orion钢板或AO钢板固定。对未复位的后方有关节突绞锁,前方有压迫的B3.2,C2.1,C3.1,C3.2型,采用后路解锁复位,前路减压钢板固定。对已完全瘫,虽然前方有压迫,但经MRI证实截瘫恢复无望C3.2型,经后路手术解锁复位AXIS固定。结果22例术后颈椎即获稳定,恢复脊柱正常序列,曲度及椎体高度,植骨融合。术后神经功能完全瘫7例无改善,15例不全瘫均有改善。结论下颈椎骨折脱位应根据其类型及脊髓损伤情况选择不同手术方法,以较好的满足下颈椎骨折脱位治疗需要。

Objective To discuss selection of surgical treatment for inferior cervical fracture and dislocation. Methods According to AO classification, 22 cases of inferior cervical fracture and dislocation comprised 10 cases of type B 3.1, 1 type B 3.2, 6 type C 2.1, 2 type C 3.1, and 3 type C 3.2. Conventional skull traction was done for the patients. Anterior decompression and fixation with Orion or AO Plate were applied for all the reduced types by traction and the unreduced type B3.1. The posterior unlocking reduction, anterior decompression and plate fixation were applied for types B 3.2, C 2.1, C 3.1, and C 3.2 which suffered from unreduction, locked posterior articular process and anterior compression. The posterior unlocking reduction and AXIS fixation were applied for type C 3.2 which suffered from anterior compression and hopeless paraplegia. Results After operation all the cases had stable cervical vertebrae, and resumed the normal order, curvature and height of vertebral body and fusion. 7 cases with neural function panplegia did not gain improvement, but 15 cases without panplegia gained improvement. Conclusion Inferior cervical fracture and dislocation should be treated by different surgical treatments according to its type and severity of spinal injury so that satisfactory outcomes can be achieved.