前后联合路入路治疗下颈椎骨折脱位伴关节突交锁的疗效观察

【作者】 唐强； 齐保闯； 徐显春；

【机构】 宜宾市第一人民医院骨一科；

【摘要】 目的探讨一期经前后联合入路治疗伴有难复位性关节突交锁的颈椎骨折脱位的疗效。方法对2007年3月至2015年6月收治的28例伴有难复位性关节突交锁的颈椎骨折脱位患者的临床资料进行回顾性分析,男19例,女9例;年龄18—71岁,平均44.5岁;神经损害程度按照美国脊髓损伤学会(AISA)评分:A级1例,B级11例,C级12例,D级4例。均采用一期颈椎后路小关节撬拨术联合前路椎体间融合手术内固定治疗。观察术后Frankel分级评定、JOA评分及前凸cobb角改善情况。结果本组手术时间3.2~5.3 h,平均4.1 h;术中出血量500~1300 m L,平均750m L。所有患者随访12~36个月,平均21个月。术后3.5个月椎体间获得牢固的骨性融合,螺钉无松动、断裂。患者伤口均一期愈合,多数患者脊髓功能有不同程度的改善,出院时脊髓功能改善率为58%。JOA评分由术前(6.1士0.7)分改善至术后1年(13.3±0.8)分,差异有统计学意义(t=11.58,P=0.000);中立位C:一C,前凸cobb角由术前7.50士0.62改善至术后1年17.48±0.82。,差异有统计学意义(t=9.40,P=0.000)。结论采用一期颈椎前后联合入路手术治疗伴有难复位性关节突交锁的颈椎骨折脱位,可早期恢复颈椎生理曲度,稳定损伤颈椎,解除脊髓压迫、改善神经功能,疗效明确。更多还原

【Abstract】 Treatment of lower cervical fracture dislocation and articular process interlocking by one-stage anteroposterior approach. TANG Qiang,QI Bao-chuang,Xu Xian-chun,(Dept ofOrthopaedics,Yibin People’s Hospital, Yibin, Sichuan,China,644000).Methods From March 2007 to June 2015,twenty-eight cases were accompanied with spinal cord injury,including 1 casesof A type,11 cases of B type,12 cases of C type,and 4 cases of D type based on the nerve function according to American Spinal Injury Association( ASIA)classification criteria. All the patientswere treated with reduction and fixation through ananterior and posterior approach. The segmental stability and bone graft fusion is postoperative radiation evaluated through the postoperative radiographic examinations, the neurological status was reviewed preoperatively and postoperatively; Application Frankel classification evaluation, JOA score and lordosis cobb Angle to evaluate the recoveryafter surgery.Results The mean operation time was 4.1 h(range,3.2-5.3 min). Intraoperative blood loss was 750 ml on average(range 500-1300ml).The mean follow-up lasted for 21 months on average(range, 12-36months) in all 28 patients. Four months after the operation, solid bony fusion between vertebral body. NO found screw loosening. All the wound healed, and the spinal cord function improvedin the majority of patients,. The spinal cord function improved at discharge was 58%.There was no implant breakage and mesh displacement or collapse.According to the American Spinal InjuryAssociation(ASIA)score,preoperative neurologic deficit restored by mean one grade at final follow—up.The neurological fuction of one patients with complete spinal cord inury( SCI) not improvedat all. The average American Spinal Cord Injury Association( ASIA) neurological function scale was improved by 1- 2 levels.The average score of ASIA sense and motor,Japanese OrthopaedicsAssociation( JOA) were apperantly improved respectively,at final follow-up.The difference was statistically significant.Conclusion One-stage anteroposterior approach had a satisfactory clinicaleffect in treating sever lower cervical fracture dislocation and irreducible articular process interlocking.更多还原