齿状突骨折合并无骨折脱位型下颈髓损伤的诊治

发布时间：2018-05-06 05:01

  本文选题：齿状突骨折 + 颈髓损伤　； 参考：《中国修复重建外科杂志》2017年08期

【摘要】：目的探讨齿状突骨折合并无骨折脱位型下颈髓损伤的特点、机制和诊治策略。方法回顾分析2007年6月—2015年10月收治的符合选择标准的7例齿状突骨折合并无骨折脱位型下颈髓损伤患者临床资料。患者均为男性,年龄37~71岁,平均51.4岁。致伤原因:交通事故伤2例,摔伤2例,击打伤3例。受伤至入院时间2 h~3 d,平均9 h。齿状突骨折采用Anderson-Grauer分型,ⅡA型1例,ⅡB型3例,ⅡC型2例,浅Ⅲ型1例。颈髓损伤受累节段:C_(4、5) 1例,C_(4~6) 2例,C_5~7 4例。颈椎退变程度:轻度2例,中度3例,重度2例。无骨折脱位型下颈髓损伤采用下颈椎损伤分型系统评分(SLIC)为4~6分,平均5.1分。枕颈部疼痛采用疼痛视觉模拟评分(VAS)为(7.8±1.0)分。神经功能采用ASIA分级,B级1例,C级4例,D级2例;日本骨科协会(JOA)评分为(9.2±3.9)分。齿状突骨折采用前路螺钉固定术4例,后路寰枢椎固定融合术3例;下颈髓损伤采用前路椎体次全切除钛网植骨融合术4例,椎间盘切除Cage植骨融合术3例。结果手术时间178~252 min,平均210.2 min;术中出血量60~140 m L,平均96.5 m L,均未输血。术后切口均Ⅰ期愈合。7例患者均获随访,随访时间12~66个月,平均18个月。均未出现与颈椎手术直接相关的并发症。术后植骨均完全融合,融合时间6~9个月,平均7.7个月。随访期间未见内固定物松动、脱落。末次随访时枕颈部疼痛VAS评分为(1.7±0.7)分,JOA评分为(15.1±1.7)分,均较术前显著改善(t=18.064,P=0.000;t= 7.066,P=0.000)。末次随访时神经功能ASIA分级为D级5例,E级2例,与术前比较差异有统计学意义(Z= 2.530,P=0.011)。结论复合暴力和下颈椎退变是齿状突骨折合并无骨折脱位型下颈髓损伤的主要原因,依据齿状突骨折的类型与下颈髓的损伤状态制定并实施一期手术可获满意疗效。
[Abstract]:Objective to investigate the characteristics, mechanism, diagnosis and treatment of cervical spinal cord injury without fracture and dislocation of odontoid process fracture. Methods from June 2007 to October 2015, 7 patients with odontoid process fracture with no fracture and dislocation were retrospectively analyzed. The clinical data of 7 patients with cervical spinal cord injury without fracture and dislocation were analyzed retrospectively. All the patients were male, aged 3771 years (mean 51.4 years). The causes of injury were traffic accident in 2 cases, fall in 2 cases and hit injury in 3 cases. The time from injury to admission was 2 hours and 3 days, with an average of 9 hours. Anderson-Grauer classification was used for odontoid fracture. Type 鈪，

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