【摘要】 目的观察在严重低位颈椎骨折脱位患者治疗中,一期前后路联合手术对患者的远期疗效和并发症的影响。方法选取2011年1月至2017年1月收治的严重低位颈椎骨折脱位患者88例为研究对象,按照手术类型分为对照组与研究组,每组44例。对照组接受前路复位减压植骨内固定手术治疗,研究组接受一期前后路联合复位减压植骨内固定手术治疗。记录两组手术情况、术前及术后12个月Cobb角、椎体位移距离及日本骨科协会(JOA)评分,比较两组并发症情况。结果研究组手术时间、术中出血量及骨折愈合时间与对照组比较差异无统计学意义(P均> 0. 05)。术后12个月两组Cobb角、椎体位移距离均较术前显著减小(P均<0. 01),且研究组显著小于对照组[(5. 36±0. 79)°vs (12. 52±1. 88)°,P <0. 01;(3. 52±0. 48) mm vs (6. 84±1. 03) mm,P <0. 01]。术后12个月两组JOA评分均较术前显著升高(P均<0. 01),且研究组显著高于对照组(P <0. 01)。研究组术后并发症发生率显著低于对照组(4. 55%vs 22. 73%,P <0. 05)。结论一期前后路联合手术可提高严重低位颈椎骨折脱位远期疗效,促进颈椎功能恢复,减少术后并发症的发生。更多还原

【Abstract】 Objective To observe the long-term effect of one-stage anterior and posterior combined approach operation in patients with severe low cervical spine fracture and dislocation and the influences on functional recovery and complications.Methods A total of 88 patients with severe low cervical spine fracture and dislocation from January 2011 to January 2017 were selected and divided into control group and study group according to the type of operation(n = 44,each). The anterior replacing and decompressive bone-grafting internal fixation was performed in control group,and the first-stage anterior and posterior combined approach replacing and decompressive bone-grafting internal fixation was performed in study group. The surgical condition,Cobb angle,vertebral displacement and Japanese Orthopedics Association(JOA) score were recorded before and 12 months after operation,and the complications were compared between two groups. Results There were no significant differences in operative time,intraoperative blood loss and fracture healing time between two groups(all P >0. 05). At 12 months after operation,Cobb angles and vertebral displacement distance significantly decreased compared with those before operation in both two groups(all P < 0. 01) and were significantly lower in study group than those in control group [(5. 36 ± 0. 79) ° vs(12. 52 ± 1. 88) °,(3. 52 ± 0. 48) mm vs(6. 84 ± 1. 03) mm,respectively,P < 0. 01].Compared with pre-operation,JOA scores significantly increased after operation in both two groups(all P < 0. 01) and was significantly higher in study group than that in control group(P < 0. 01). The incidence rate of postoperative complications in study group was significantly lower than that in control group(4. 55% vs 22. 73%,P < 0. 05). Conclusion The onestage anterior and posterior combined approach operation can advance the long-term effect of the severe low cervical spine fracture and dislocation,promote the recovery of cervical vertebra function and reduce postoperative complications.更多还原