不稳定型下颈椎损伤的手术治疗(附56例分析)

Surgical treatment of unstable lower cervical spine injury:analysis of 56 cases

目的分析手术治疗下颈椎不稳定性损伤的适应证、手术方法及疗效。方法2001年1月～2003年1月,手术治疗下颈椎不稳定性损伤共56例。参照Aebi及White等人的手术适应证,以前路手术为主;对于难复性颈椎脱位或不伴椎间盘损伤者,行后路施术或前后联合入路手术;稳定性评分大于8分的前后柱损伤者,行前后联合入路手术。以Frankel评分系统评价神经功能恢复情况,以损伤节段Cobb角及水平移位来评价复位情况,采用Bohlman的X线片标准判定植骨融合情况。结果Frankel评分术前平均为2.3分,术后3.1分;按Bohlman标准3个月时植骨融合率为80%,6个月时为100%。术前Cobb角平均为8°,术后为1.5°,水平移位由术前的平均3.5mm减小到0.5mm。结论手术治疗下颈椎不稳定性损伤具有改善神经功能、恢复颈椎序列、恢复椎间高度及生理曲度、可早日下地活动等优点,手术病例及方法的选择应根据患者是否有致压因素及颈椎稳定性等综合考虑。

Objective To analyze the indication, operative methods and outcome of surgical treatment for unstable lower cervical spine injuries. Methods From January 2001 to January 2003, 56 cases of unstable lower cervical spine injury were treated surgically. Most of the patients were treated through anterior approach for decompression and/or fusion. Posterior approach was used for dislocation without disc herniation, and combined anterior and posterior approaches were used for irreducible dislocation accompanied with disc injury and for patients with lesion of anteroposterior columns whose stability score was over 8 by White criteria. Their neurological function was assessed by Frankel criteria, reduction was evaluated by Cobb angle and transverse displacement, and bone arthrodesis was assessed by Bohlman radiographic criteria. Results The Frankel score increased from 2.3 preoperatively to 3.1 postoperatively. The rate of bone fusion reached up to 80%3 months after operation and 100%6 months after operation. The Cobb angle decreased from 8°preoperatively to 1.5°postoperatively, and the transverse displacement decreased from 3.5mm to 0.5mm after operation. Conclusions The surgical treatment for unstable lower cervical injury can promote the recovery of neurological function, and restore the lordosis and alignment of cervical spine. Possible compression factors and stability degrees of the cervical spine should be taken into careful consideration when determining the patient to be operated on and choosing the operative method.