颈椎前路撑开螺钉提拉复位技术治疗外伤性颈椎骨折脱位

发布时间：2018-06-18 04:48

本文选题：颈椎 + 骨折　；参考：《中国矫形外科杂志》2017年08期

【摘要】：[目的]分析证明颈前路撑开螺钉提拉复位技术较常规前路复位技术在治疗外伤性颈椎骨折脱位的优势。[方法]收集2008年1月~2014年6月采用Ⅰ期前路治疗牵张屈曲分离型双侧关节突交锁的86例外伤性颈椎骨折脱位患者,男54例,女32例;年龄20~73岁,平均(40.1±5.6)岁。按照入院顺序分配到颈前路常规复位(44例)和颈前路撑开螺钉提拉复位(42例)。比较两组间术中出血量、手术时间、术后椎体复位率,术后随访12~18个月,通过Frankel’s评分、JOA评分、VAS评分对其疗效进行评定。[结果]两组手术时间及颈椎脱位矫正率的组间比较差异有统计学意义(P0.05),提拉复位组优于常规复位组。两组术后Frankel’s评分、VAS评分、JOA评分均较术前明显改善,差异有统计学意义(P0.05);三项评分组间比较差异无统计学意义(P0.05)。[结论]颈前路撑开螺钉提拉复位技术操作简单、操作风险低、手术时间短,术中椎体复位效果及术后功能恢复良好,同时可减少常规复位法中因撬拨或复位中关节弹跳引起的颈髓医源性损伤及术后并发症,是一种安全有效的治疗颈椎骨折脱位的手术方法,较常规手术复位组有明显优势,中长期随访颈椎稳定性良好,适合临床推广应用。
[Abstract]:[objective] to prove the advantage of anterior cervical distraction screw lifting reduction technique in the treatment of traumatic cervical fracture and dislocation. [methods] from January 2008 to June 2014, 86 patients (54 males and 32 females) with traumatic cervical fracture and dislocation were treated with stage I anterior approach. The average age was 40.1 卤5.6 years, aged 20 to 73 years. According to the order of admission, 44 cases were assigned to the anterior cervical approach (n = 44) and 42 cases to the anterior cervical open screw lifting reduction (n = 42). The amount of blood loss, the time of operation, the rate of reduction of vertebral body after operation were compared between the two groups. The curative effect was evaluated by Frankelos score and JOA score and VAS score after follow-up for 12 ~ 18 months. [results] the difference of operation time and cervical dislocation correction rate between the two groups was statistically significant (P 0.05), and the lifting reduction group was superior to the conventional reduction group. The scores of Frankelos and VAS and JOA in the two groups were significantly improved compared with those before operation, and the difference was statistically significant (P 0.05), but there was no significant difference among the three groups (P 0.05). [conclusion] the technique of lifting reduction of anterior cervical distraction screw is simple, low risk, short operation time, good reduction effect during operation and good recovery of function after operation. At the same time, it can reduce the iatrogenic injury and postoperative complications of cervical spinal cord caused by prying or joint bounce in conventional reduction. It is a safe and effective surgical method for the treatment of fracture and dislocation of cervical vertebra, and has obvious advantages over conventional surgical reduction group. The long-term follow-up of cervical vertebrae is stable and suitable for clinical application.
【作者单位】：同济大学附属东方医院脊柱外科;中国人民解放军第303医院;
【基金】：国家自然基金资助项目(编号:81371994) 浦东新区卫生系统重点学科建设资助项目(编号:PWZx2014-02)
【分类号】：R687.3

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