下颈椎骨折脱位的术式选择及疗效分析

发布时间：2018-10-05 17:47

【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:收集我院自2009年1月至2013年9月收治的单节段下颈椎骨折脱位患者126名,男性86例,女性40例,年龄16-72岁,平均46.4岁。按照ASIA分级标准进行分级:A级7例,B级48例,C级54例,D级17例。术前进行SLIC评分,其中4分13例,5分24例,6分23例,7分29例,8分17例,9分13例,10分7例,根据患者受伤机制、形态特点、脊髓受压部位及损伤程度等因素进行分析,选择手术方案,其中85例采用单纯前路手术治疗;12例行后路手术;29例严重的骨折脱位,采用前后联合入路。随访患者神经功能改善情况,影像学评价脱位改善程度及植骨融合情况,分析三种术式SLIC评分分布特点。结果:126例均顺利完成手术,无气管、食管损伤,无神经损伤加重。术后佩戴颈托3个月,均获随访,随访时间18个月,术后6个月复查,除了4例A级无恢复,1例B级无恢复,其余患者ASIA损伤程度分级平均提高1.2级。术后复查X线片示颈椎序列恢复良好,病例植骨均在18个月内骨性融合(平均8.5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,前后联合术式患者评分基本都大于8分。结论:下颈椎骨折脱位的术式选择,需要根据受伤机制、具体损伤形态、脊髓受压部位及损伤程度等因素进行综合分析,选择合理的入路,有助于复位骨折脱位、解除神经压迫、促进神经功能的恢复、提高植骨融合率。SLIC评分反映了下颈椎骨折脱位的损伤程度,有助于选择手术入路,SLIC评分大于等于8分时提示做前后联合术式。合理选择手术入路有利于减少手术并发症。
[Abstract]:Objective: to explore the choice of surgical methods and the curative effect of fracture and dislocation of lower cervical vertebra. Methods: from January 2009 to September 2013, 126 patients (86 males and 40 females, aged 16-72 years, with an average of 46.4 years) were enrolled in our hospital. According to ASIA classification standard, 7 cases of grade A, 48 cases of grade B, 54 cases of grade C and 17 cases of grade D were classified. Preoperative SLIC score was performed in 13 cases with 4 points, 24 cases with 5 points, 23 cases with 6 points, 29 cases with 7 points, 17 cases with 8 points, 13 cases with 9 points and 7 cases with 10 points. Among them 85 cases were treated with anterior approach alone and 29 cases with severe fracture and dislocation were treated by posterior approach and combined anterior and posterior approach. The neurologic function was improved, the degree of dislocation improvement and bone graft fusion were evaluated by imaging, and the distribution characteristics of SLIC score of the three operations were analyzed. Results all 126 cases were successfully operated without trachea, esophagus injury and nerve injury. All the patients were followed up for 3 months and followed up for 18 months. 6 months after operation, except for 4 cases of grade A without recovery and 1 case of grade B without recovery, the grade of ASIA damage increased by 1.2 grade on average. The results of X-ray examination showed that the sequence of cervical vertebrae recovered well, and the bone grafts of all cases were fused within 18 months (mean 8.5 months), no pseudarthrosis, nonunion, height of vertebral body, physiological curvature and stability of cervical vertebrae were maintained well. The scores of patients with combined operation before and after operation were above 8. Conclusion: the choice of operation method for fracture and dislocation of lower cervical vertebrae should be analyzed synthetically according to injury mechanism, specific injury form, compression position of spinal cord and degree of injury, and choosing reasonable approach is helpful for reduction and dislocation of fracture and dislocation. Relieving the nerve compression, promoting the recovery of nerve function, improving the fusion rate of bone graft. SLIC score can reflect the injury degree of fracture and dislocation of the lower cervical spine, which is helpful to suggest the combined operation method when the SLIC score of the operative approach is greater than or equal to 8 minutes. Reasonable choice of operative approach is helpful to reduce the complications of operation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【共引文献】