下颈椎骨折脱位的治疗术式选择

Surgical option of lower cervical spine fracture and dislocation

中文关键词:  骨折脱位  下颈椎  手术  选择

英文关键词:Fracture and dislocation  Lower cervical  Operation  Procedure

中文摘要:

  【摘要】 目的：探讨下颈椎骨折脱位的手术方式选择及其疗效。方法：我院2007年1月至2012年10月收治下颈椎骨折脱位患者32例，男23例，女9例；年龄28~78岁，平均56.4岁。术前伴脊髓损伤22例，Frankel分级A级5例，B级9例，C级6例，D级2例。根据患者骨折类型、椎间盘突出及压迫脊髓程度、小关节交锁情况、颈椎损伤程度等因素选择手术方案，其中21例椎体骨折但不伴有椎间小关节绞锁的病例采用单纯前路手术治疗（单间隙或椎体次全切除减压、椎间植骨钢板内固定）；4例颈椎脱位伴有小关节绞锁但不伴有明显的椎体骨折、MRI示脊髓前方无明显受压，或屈曲牵张型双侧关节突骨折/绞锁者行后路减压、复位、内固定；7例有椎体骨折和椎间盘损伤，并存在椎体脱位、椎间小关节绞锁，或椎板骨折、骨块脱入椎管者采用前后联合入路手术。随访患者神经功能改善情况，影像学评价骨折愈合、植骨融合及颈椎稳定性情况。结果：32例均顺利完成手术，术中无神经、气管和食管损伤等并发症。4例术中发现硬脊髓破损，术后发生脑脊液漏，经对症处理后愈合。术后佩戴颈托3个月。均获随访，随访时间6～24个月，平均18.5个月，术后6个月22例有脊髓神经功能损伤患者除1例B级无恢复外，其余患者Frankel分级提高1~2级。术后复查X线片示颈椎序列恢复良好，骨折愈合，植骨均在6个月内获骨性融合（平均4.5个月），无假关节、骨不连发生，椎体间高度、生理曲度及颈椎稳定性维持良好，随访期间无钢板螺钉脱出、断裂。结论：术前对下颈椎骨折脱位患者的损伤类型、损伤节段、颈椎间盘突出压迫脊髓位置及受伤程度等因素进行综合分析，采取合理的手术方式，能够使损伤节段获得早期稳定，有利于提高患者神经功能的恢复。

英文摘要:

  【Abstract】 Objectives: To explore the surgical option and clinical efficacy of lower cervical spine fracture and dislocation. Methods: A total of 32 patients including 23 males and 9 females with a mean age of 56.4 years(ranging from 28 to 78) with lower cervical spine fracture and dislocation and treated surgically from January 2007 to October 2012 was analyzed retrospectively. 22 patients suffered from neurological deficit. Based on Frankel system, 5 cases were grade A, 9 were grade B, 6 were grade C, and 2 were grade D before surgery. Surgical approaches were determined based on the type of fracture, herniated disc, spinal cord compression, facet joint locking and cervical spine injury degree. Anterior surgery was performed on 21 cases with vertebral fractures but no facet joint locking(anterior cervical discectomy or corpectomy and fusion). Posterior treatment was performed on 4 cases with facet joint locking but no significant vertebral fractures, and MRI finding of no significant pressure or flexion distraction fracture combined with bilateral facet fractures. Combined posterior and anterior approach was performed in 7 cases with vertebral fractures and disc injury associated with facet joint locking or lamina fractures, with the fracture fragments penetrating into the spinal canal. During follow-up, the neurofunction, bony fusion and spine stability were reviewed. Results: All patients underwent surgery safely without severe complications such as tracheal and esophageal injury, 4 patients were found complicated with spinal cord injury and cerebrospinal fluid leakage during operation and the wound heal after corresponsive intervention. Postoperatively, all patients were immobilized in a hard collar for 3 months. The average follow-up time was 18.5 months(range, 6-24 months). 1-2 degree of neurofunction recovery was achieved in all cases except 1 case with Frankel B. X ray verified the proper position of the screws after operation. Fusion achieved in all cases within 6 months(mean 4.5 months). There was no pseudarthrosis or nonunion occurred. The interbody height, physiological curvature and cervical stability maintained well. No instrument failure such as loosening, displacement or breakage was noted. Conclusions: Injury type, number of segment, degree of herniated disk and compression of spinal cord after cervical fracture and dislocation should be considered before surgery. Ideal operation can ensure early stabilization and neurofunction recovery.