下颈椎陈旧性小关节损伤治疗方法分析-36例报告

发布时间：2018-11-13 13:16

【摘要】：目的：探讨下颈椎陈旧性小关节损伤的治疗策略与疗效。方法：回顾性研究2010年1月-2014年1月，手术治疗陈旧性颈椎小关节损伤患者36例。其中男29例，女7例；年龄21-62岁，平均年龄36.4岁。受伤至就诊时间23天-4个月，平均40.6天。根据Kotani侧块及关节突关节骨折分型，分离型19例，粉碎性骨折4例，劈裂型骨折10例，创伤性椎体滑脱3例。术前术后通过Frankel及JOA评分系统评价损伤程度和术后恢复情况。结果：所有患者均行手术治疗，其中后入路椎弓根钉棒系统内固定手术6例，后-前-后联合入路椎弓根钉棒系统内固定手术4例，前入路自体骨融合锁定钛板内固定手术26例。随访6个月至2年，平均随访13.9个月。Frankel评分术后改善1级18例，改善2级17例，改善3级1例。JOA改善率57.1%-92.3%，平均75.3%。随访6个月，融合节段均获得骨性愈合，无钢板、螺钉、钉棒松动断裂等并发症。结论：下颈椎陈旧性小关节损伤手术治疗的关键是后路对绞锁的关节突的松解及解剖复位。分离型、粉碎性和劈裂型陈旧性小关节损伤，，需要依据患者神经压迫情况选择术式；创伤性椎体滑脱型陈旧性损伤，首选单纯后入路颈椎复位内固定，术中决定是否追加前路再松解植骨融合，并同期后路内固定。
[Abstract]:Objective: to investigate the treatment strategy and curative effect of old facet joint injury of lower cervical spine. Methods: from January 2010 to January 2014, 36 patients with old cervical facet joint injury were treated surgically. There were 29 males and 7 females, aged 21-62 years, with an average age of 36.4 years. The time from injury to consultation was 23 days-4 months, with an average of 40.6 days. According to the classification of Kotani lateral mass and articular facet fracture, there were 19 cases of separate type, 4 cases of comminuted fracture, 10 cases of split fracture and 3 cases of traumatic spondylolisthesis. The degree of injury and postoperative recovery were evaluated by Frankel and JOA scoring system before and after operation. Results: all the patients were treated by operation, including 6 cases of posterior pedicle screw and rod system fixation, 4 cases of posterior anterior posterior combined approach pedicle screw rod system internal fixation. Anterior approach autogenous bone fusion locking titanium plate fixation in 26 cases. The patients were followed up for 6 months to 2 years and followed up for an average of 13.9 months. There were 18 cases of grade 1 improvement, 17 cases of improvement of grade 2 and 1 case of improvement of grade 3 after Frankel scoring. The improvement rate of JOA was 57.1% -92.3% (mean 75.3%). Follow up for 6 months showed that bone healing was achieved in fusion segment without complications such as steel plate screw loosening fracture and so on. Conclusion: the key to the surgical treatment of the old facet joint injury of the lower cervical spine is the release and anatomical reduction of the strangulated articular process. Separation type, comminuted type and split type old facet joint injury, need to choose according to the patient's nerve compression condition. Traumatic spondylolisthesis type old injury, the first choice is simple posterior approach cervical spine reduction and internal fixation, during the operation decide whether to add anterior approach and release bone graft fusion, and at the same time, posterior internal fixation.
【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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