【摘要】 背景:下颈椎屈曲牵张性Ⅰ度损伤常不合并脊髓神经症状,影像学检查也无骨折脱位,临床上极易被忽视而导致迟发性脱位、后凸畸形及神经损害。目的:探讨颈椎前路手术治疗下颈椎屈曲牵张性Ⅰ度损伤后迟发性脱位的临床疗效。方法:回顾性分析2010年1月至2018年12月收治的下颈椎屈曲牵张性Ⅰ度损伤后迟发性脱位10例患者。入院后均行颅骨牵引,6例患者行颈椎前路椎间盘切除椎间融合术(ACDF),4例患者行颈椎前路椎体次全切除减压融合术(ACCF),术后费城颈托固定12周。记录患者手术前后疼痛视觉模拟评分(VAS)和脊髓损伤ASIA神经功能分级。测量患者手术前后损伤节段Cobb角和脱位椎体水平位移以评估脱位复位效果。采用Eck融合分级标准评价植骨融合情况。结果:10例患者均顺利完成手术,手术时间60～100 min,平均(73±9) min,出血量30～100ml,平均(66±12) ml。术后1周及末次随访时患者疼痛VAS评分、损伤节段Cobb角、脱位椎体水平位移均较术前改善,且差异均有统计学意义(P均<0.05)。末次随访时10例患者神经功能均恢复正常。依Eck融合分级标准,术后12个月,8例患者植骨融合达到Ⅰ级,2例患者达到Ⅱ级,融合率100%。结论:颈椎前路手术治疗下颈椎迟发性脱位可获得满意的效果。更多还原

【Abstract】 Background:Nerve symptoms usually do not present in patients with flexion-distraction stageⅠinjury in subaxial cervical spine,and there is no fracture or dislocation in imaging examination.Therefore,it is easily missed in clinic and leads to delayed dislocation,kyphosis and nerve damage.Objective:To investigate the clinical effect of anterior cervical spine surgery on the delayed dislocation in patients with flexion-distraction stageⅠinjury in subaxial cervical spine.Methods:A retrospective analysis was performed in 10 patients with delayed dislocation after flexion-distraction stageⅠinjury in subaxial cervical spine who were admitted to our hospital from January 2010 to December 2018.All the patients underwent cranial traction after admission.Six patients underwent anterior cervical discectomy and interbody fusion (ACDF).Four patients received anterior cervical subtotal vertebral body resection,decompression and fusion (ACCF).Philadelphia cervical collar was used for 12 weeks after surgery.The visual analogue scale (VAS),ASIA neurological function classification of spinal cord injury,Cobb angle of injured segments and horizontal displacement of dislocated vertebrae were measured before and after the operation.The Eck fusion grading was used to evaluate the bone graft fusion.Results:All the patients underwent surgery successfully.The mean operation time was (73±9) min (range,60-100 min).The mean blood loss was (66±12) ml(range,30-100 ml).The VAS score,Cobb angle of the injured segments,and horizontal displacement of the dislocated vertebral body were significantly improved at 1 week after operation and at the last follow-up (P<0.05).At the last follow-up,the nerve function of the 10 patients returned to normal.According to the Eck fusion grading,with bone graft fusion reached gradeⅠin 8 patients and grade II in 2 patients 12 months after the operation,and the fusion rate was 100%.Conclusions:Anterior cervical surgery can achieve satisfactory results for the treatment of delayed dislocation.更多还原