下颈椎骨折脱位并脊髓损伤的前路手术治疗

Anterior approach for lower cervical spine fractures and dislocations combined with spinal cord injury

中文关键词:  下颈椎  骨折  脱位  前路途径  脊髓损伤

英文关键词:Lower cervical spine  Fracture  Dislocation  Anterior approach  Spinal cord injury

中文摘要:

  【摘要】 目的：探讨颈椎前路手术在治疗下颈椎骨折脱位并脊髓损伤中的复位率及临床疗效。方法：2006年1月～2011年1月，我院采用前路手术治疗下颈椎骨折脱位伴脊髓损伤患者196例，168例患者资料完整并获得随访，男123例，女45例，年龄18～71岁，平均38.7岁。ASIA分级A级21例，B级46例，C级60例，D级41例；按脱位程度Ⅰ度79例，Ⅱ度42例，Ⅲ度31例，Ⅳ度16例。所有患者术前先行小重量颅骨牵引（2～4kg），随后在全麻下行颈椎前路手术进一步复位，先行损伤节段椎间盘切除，以Caspar撑开器撑开复位；不能复位者，行脱位椎体次全切除，再次复位；仍不能复位者，则一期行后路松解，再行前路手术。结果：168例中经颈前路手术复位者为88.1%（148/168），其余11.9%（20/168）则通过前路-后路-前路手术获得复位。89.9%（151/168）获得了完全复位，10.1%（17/168）获得了90%以上的复位。平均随访30.7个月，死亡19例，失访9例，140例仍在随访中。术后6个月均获得骨性融合，颈椎椎间高度和生理曲度维持良好，无钢板螺钉并发症。术后发生声音嘶哑4例，咽喉疼痛17例，髂骨取骨区麻木18例，给予对症治疗后均好转。术后153例脊髓损伤者神经功能获得改善。结论：下颈椎骨折脱位并脊髓损伤，可通过前路手术治疗使颈椎获得即刻的稳定，防止继发性脊髓损伤，改善脊髓的功能状况。

英文摘要:

  【Abstract】 Objectives: To discuss the clinical outcome of anterior surgical treatment for lower cervical spine fractures and dislocations combined with spinal cord injury. Methods: From January 2006 to January 2011, 196 patients suffering from lower cervical spine fractures and dislocations combined with spinal cord injury in our hospital were reviewed retrospectively. 168 cases were data integrity and obtained follow-up, there were 123 males and 45 females with an average age of 38.7 years old(range, 18-71 years). 21 cases were in ASIA grade A, 46 cases in B, 60 cases in C, 41 cases in D. According to the degree of dislocation, 79 cases were in Ⅰ, 42 cases in Ⅱ, 31 cases in Ⅲ, 16 cases in Ⅳ. All cases underwent skull traction(2-4kg) before operation. And then anterior discectomy and reduction by Caspar distractor, if the reduction failed, the corpectomy was performed for further reduction. If the reduction still failed, the posterior approach was performed. Results: In this group, 148 patients(88.1%, 148/168) got reduction by anterior approach alone, the other 20 patients(11.9%, 20/168) got reduction by combined anterior and posterior approach. 151 cases(89.9%) got complete reduction, 17(10.1%) obtained reduction of more than 90%. The average follow-up time was 30.7 months. 140 patients were followed-up, 9 patients lost follow-up, and 19 patients lost follow-up due to death. All patients got bony fusion 6 months after operation. The normal disc height and lordosis were maintained. There were no plate and screw-related complications. The other complications including 4 cases suffered from hoarseness, 17 cases suffered from throat pain, 18 cases suffered from numbness in iliac region, all of them got relieved after treatment. 153 cases with neurological deficit improved significantly. Conclusions: For lower cervical spine fractures and dislocations, anterior approach can not only obtain the satisfactory reduction and immediate stability, but also prevent secondary spinal cord injury and improve the spinal cord function.