前路复位减压零切迹椎间融合器内固定治疗下颈椎脱位

Anterior reduction and decompression for the treatment of lower cervical spine dislocation by zero profile anterior cervical interbody fusion system

中文关键词:  颈椎  关节脱位绞锁  零切迹椎间融合器

英文关键词:Cervical vertebra  Facet joint dislocation  Zero profile anterior cervical interbody fusion system

中文摘要:

  【摘要】 目的：探讨一期颈椎前路复位、减压、零切迹椎间融合器内固定术治疗下颈椎脱位的效果。方法：2010年10月～2013年6月收治25例不合并椎板骨折内陷的下颈椎脱位患者，脊髓损伤程度按照Frankel分级：A级4例，B级10例，C级6例，D级4例，E级1例；损伤部位：C3/4 2例，C4/5 5例，C5/6 8例，C6/7 10例；单侧关节突脱位绞锁8例，双侧关节突脱位绞锁17例；受伤至入院时间2h～3d，平均7.6h。均急诊全麻下一期行颈椎前路复位、减压、零切迹椎间融合器内固定治疗，复位方法包括全麻下颅骨牵引、椎体间撑开撬拨复位。结果：全麻下颅骨牵引重量10~15kg，时间10~30min，13例复位，12例未复位。12例颅骨牵引未复位患者中，8例单侧关节突绞锁患者于术中通过椎间盘切除减压后偏中心椎体间撑开、单侧撬拨全部复位，4例双侧关节突绞锁患者通过椎间盘切除减压后椎体间撑开、撬拨复位。手术时间为61±12min（40~82min），术中出血量为180±25ml（100~600ml）。术后出现脑脊液漏1例，未发生大血管、喉返神经损伤或气胸等并发症，无1例出现术后吞咽不适感。随访6.8±2.2个月（5~12个月）。术后3~5个月影像学复查示椎间植骨均获骨性愈合；25例颈椎序列好、内固定位置良好、无内固定移位及断裂。末次随访时，A级2例、B级3例、C级1例、D级1例、E级1例脊髓功能无变化，其余患者脊髓功能均有不同程度改善。JOA评分由术前7.2±0.8分改善至末次随访时的13.8±0.6分，改善率为67.3%。结论：一期全麻下颈椎前路复位、减压、零切迹椎间融合器内固定术治疗下颈椎脱位可达到早期复位、减少脊髓受压时间、手术时间短、固定可靠、减少术后吞咽不适感发生率、疗效满意的效果。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of anterior cervical decompression, reduction and internal fixation with zero profile interbody fusion system for the treatment of lower cervical spine dislocation. Methods: 25 cases suffering from dislocation of the lower cervical spine and without merge laminar fracture were reviewed retrospectively, the Frankel grade included: grade A in 4 cases, grade B in 10 cases, grade C in 6 cases, grade D in 4 cases, and grade E in 1 case. Injury site included: C3/4 in 2 cases, C4/5 in 5 cases, C5/6 in 8 cases, C6/7 in 10 cases. The duration from injury to the admission was 2h-3d, with an average of 7.6h. Unilateral facet lockage was noted in 8 cases, and bilateral lockage in 17 cases. 25 cases experienced anterior cervical decompression, reduction and internal fixation with zero profile interbody fusion system. Results: Under general anesthesia, the skull traction weight was 10-15kg in 10-30min, 13 cases reached reduction, while 12 cases had no effect. 8 cases with unilateral facet lockage reached reduction through discectomy and decompression; 4 patients with bilateral facet joint lockage got reduction through discectomy and distraction. The operation time was 40-82min(average 61±12min), the bleeding volume was 100-600ml(average 180±25ml). The patients were followed up for 5-12 months(average 6.8±2.2 months). 1 case was complicated with cerebrospinal fluid leakage, no complication such as major blood vessel, recurrent laryngeal nerve injury or pneumothorax was noted. No case suffered from postoperative swallowing discomfort. 3-5 months later, intervertebral bony fusion was noted, and 25 cases reached good cervical spine alignment, no internal fixation or fracture was noted. All cases except for 2 grade A, 3 grade B, 1 grade C, 1 grade D and 1 grade E had good improvement of neurofunction at final follow-up, while the rest had different degrees of improvement. Preoperative JOA score of 7.2±0.8 points improved to 13.8±0.6 of final follow-up, with the improvement rate as 67.3%. Conclusions: One stage anterior cervical reduction and decompression with zero profile anterior cervical interbody fusion system is reliable for cervical dislocation, which is of early reduction and well neurological recovery as well as less incidence of complications.