术前头环背心复位固定在颈椎骨折脱位合并强直性脊柱炎患者中的临床应用

The clinical application of Halo vest for reduction and immobilization before surgery for cervical spine fracture-dislocation in patients with ankylosing spondylitis

中文关键词:  颈椎骨折脱位  强直性脊柱炎  头环背心固定  复位  手术

英文关键词:Fracture and dislocation of cervical spine  Ankylosing spondylitis  Halo vest  Reduction  Surgery

中文摘要:

  【摘要】 目的：探讨颈椎骨折脱位合并强直性脊柱炎（AS）患者术前应用头环背心（Halo vest）复位固定的有效性及安全性。方法：回顾性分析2012年1月~2019年1月我院23例术前行头环背心复位固定的颈椎骨折脱位合并AS患者的临床资料，其中男性22例，女性1例，年龄39～64岁（53.0±7.4岁）。患者损伤平面C2/3 1例，C4/5 5例，C5/6 13例，C6/7 1例，跨椎节斜形骨折3例（C4-C5椎体2例，C5-C6椎体1例）。术后随访12~36个月，平均22.4±7.7个月。所有患者入院诊断明确后采用头环背心进行复位、固定，直至手术结束。固定前后行颈椎侧位X线片评估复位效果，记录术前术中有无骨折断端再脱位、继发性神经功能恶化。所有患者骨折复位后行单纯后路或者前后联合入路植骨融合内固定术，记录手术时间、出血量及相关并发症。术前及末次随访采用美国脊柱损伤协会（ASIA）分级标准评估患者神经功能情况，并记录椎体融合时间。结果：应用头环背心17例患者获得解剖复位，4例复位满意，2例复位失败，复位失败患者手术前全身麻醉状态下再次进行复位获得解剖复位。固定治疗期间患者均未出现骨折断端再脱位或继发性神经功能恶化。8例采用单纯后路手术，15例采用前后路联合手术。手术时间203.3±68.6min（90～375min），术中出血量275±88.9ml（120～410ml）。1例ASIA分级A级患者术后3周因肺部感染、呼吸衰竭死亡。1例术后5d发生切口感染，经清创及抗感染后痊愈，无其他严重并发症发生。末次随访时1例ASIA分级B级患者恢复至C级，5例C级患者中3例恢复至D级，16例D级患者中有13例恢复至E级，其余患者ASIA分级较术前虽未改变，但肢体肌力均有改善。术后12个月内骨折椎体均完全融合，无内固定松动、移位等。结论：术前采用头环背心复位固定在颈椎骨折脱位合并强直性脊柱炎患者中临床应用安全、有效，并有助于术中复位、简化手术操作进而提高手术安全性。

英文摘要:

  【Abstract】 Objectives: To investigate the safety and efficacy of Halo vest for the reduction and immobilization before surgery for cervical spine fracture-dislocation in patients with ankylosing spondylitis(AS). Methods: We retrospectively analyzed the clinical data of 23 AS patients with cervical fracture and dislocation underwent surgery in our department from January 2012 to January 2019. There were 22 males and 1 female, with a mean age of 53.0±7.4 years, ranging 39-64 years. C2/3 fracture occured in 1 patient, C4/5 in 5, C5/6 in 13, C6/7 in 1, and oblique fracture through vertebrae in 3(oblique fracture through C4-5 in 2 and C5-6 in 1). The mean follow-up was 22.4±7.7 months(12-36 months). A halo vest was used in each patient to reduce and immobilize the fractured spinal column ends after admission or examination, until the operation was finished. Lateral cervical X-ray examinations were performed before and after immobilization to evaluate the reduction condition. Displacement at fracture sites and secondary neurologic deterioration were recorded before and during operation. Posterior and combined anterior/posterior surgery were performed. Operation time, blood loss and complications were all recorded. American Spinal Injury Association(ASIA) impairment scale was used in grading the patients before operation and at final follow-up to evaluate the recovery of neurologic function. Besides, the time to fusion was recorded. Results: 17 patients achieved closed anatomical reduction; four achieved successful reduction, and two had reduction failure who achieved anatomical reduction after a second reduction under general anesthesia before operation. No patient presented with re-dislocation in the fracture ends or secondary neurologic deterioration during Halo vest immobilization. Eight patients underwent posterior approach alone surgery and 15 underwent one-stage combined anterior/posterior approach surgery. The operation duration was 203.3±68.6min(90-375min) and blood loss was 275±88.9ml(120-410ml). One ASIA grade A patient died 3 weeks after operation because of severe pneumonia and respiratory failure. One patient occurred incision infection 5d after operation and was cured after debridement and anti-inflammatory treatment, and no other severe complications occurred. At final follow-up, one ASIA grade B patient improved to C, 3 out of 5 grade C patients improved to D, and 13 out of 16 grade D patients improved to E. Although the others had no change in ASIA gradings, their muscle strengths were improved. The fractured vertebrae of all the patients achieved bony fusion within 12 months after operation. No patient presented with displacement, rupture or loosening of implants. Conclusions: The use of a halo vest before operation is safe and effective in AS patients with cervical fracture-dislocation, which is helpful for intraoperative reduction and simplifing the surgery and therefore improve the safety of operation.