合并双侧关节突绞锁的下颈椎骨折脱位手术治疗的理论与临床研究

发布时间：2018-05-19 04:47

本文选题：下颈椎 + 骨折脱位　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：探讨合并有双侧关节突绞锁的下颈椎骨折脱位行前路手术的必要性及可行性。方法： 1.通过综述国内外文献和我们的前期研究工作，设计并提出一种前路解锁复位的手术方式。 2.筛选2010年~2014年合并双侧关节突绞锁的下颈椎骨折脱位的病例18例。其中II°4例，III°8例，IV°5例，完全脱位1例。行前路手术并用该手术方式进行解锁复位，根据病人病情一些病例还加做后路手术，病人的脊髓和神经功能以Frankel分级进行记录和评价。结果： 1、设计并提出的前路解锁复位的手术方式是合理的，并且理论上是可行的。 2、本组全部病例得到了良好复位。5例脊髓不完全损伤者神经功能获得不同程度的改善，Frankel评分平均提高1~2级。无脊髓及神经功能加重的病例，其中1例完全脱位且无脊髓损伤，仅有双侧神经根刺激症状的病例的治疗过程提示前路手术的必要性。结论： 1.下颈椎前脱位合并双侧关节突交锁前路手术是可行的，也是必要的。 2.前路手术方式是最基本最主要的手术方式，后路手术方式是次要和辅助手术方式。 3.后路手术方式在病人全身状态允许的情况下其适应症如下： ①椎体后部结构损坏严重，且有压迫脊髓和神经根者。 ②虽通过颈椎前路手术解锁复位，但后方关节突未达到解剖复位，，并存在屈曲不稳定者。 ③病人顺应性差，或已有早期坠积性肺炎为早期坐起便于护理，需要坚强固定者。
[Abstract]:Objective: To investigate the necessity and feasibility of anterior approach for fracture and dislocation of lower cervical spine with bilateral articular process strangulation. Methods: 1. Based on the review of domestic and foreign literature and our previous research work, we designed and proposed a surgical method of anterior unlocking and reduction. 2. From 2010 to 2014, 18 cases of fracture and dislocation of lower cervical spine with bilateral articular process strangulation were selected. Among them, 2 掳4 cases had 3 掳III 掳8 cases had IV 掳5 cases, and 1 case had complete dislocation. The anterior approach was performed with the method of unlocking reduction. According to the patient's condition, some cases were operated with posterior approach. The spinal cord and nerve function of the patient were recorded and evaluated by Frankel grade. Results: 1. The designed and proposed surgical method of anterior locking and reduction is reasonable and theoretically feasible. 2. In all cases, the neurological function of 5 cases with incomplete spinal cord injury was improved in different degree. The Frankel score was improved by 1 and 2 grades on average. The treatment of one case with complete dislocation and no spinal cord injury and only bilateral nerve root irritation indicated the necessity of anterior approach operation in the patients with no exacerbation of spinal cord and nerve function. Conclusion: 1. Anterior approach for anterior dislocation of lower cervical spine with bilateral interlocking joint process is feasible and necessary. 2. The anterior approach is the most basic and the most important, while the posterior approach is secondary and auxiliary. 3. The indications for the posterior approach are as follows when the patient's overall condition permits: 1 the posterior structure of the vertebral body was severely damaged, and the spinal cord and nerve root were compressed. 2 though the anterior cervical spine was unlocked, the posterior articular process failed to achieve anatomic reduction, and there were unstable flexion in the posterior articular process. (3) patients with poor compliance, or patients with early chronoclastic pneumonia, need strong fixation for early sitting up and nursing.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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