下颈椎骨折脱位并脊髓损伤的治疗术式探讨

发布时间：2019-05-17 19:34

【摘要】：[目的]探讨不同入路手术方式治疗下颈椎骨折脱位合并脊髓损伤的临床疗效。[方法]2011年7月~2015年6月收治下颈椎骨折脱位合并脊髓损伤患者39例,术前Frankel分级A级5例,B级12例,C级14例,D级8例。根据骨折类型、脱位程度、脊髓受压评估情况、是否存在关节突骨折及交锁或者前后复合体损伤等因素选择手术方案。其中24例椎体骨折、椎间盘损伤、术前经颅骨牵引可复位者采用前路减压椎间植骨内固定术;7例颈椎脱位伴小关节骨折或脱位但不伴明显前中柱损伤者采用后路复位侧块螺钉内固定术;8例颈椎椎体骨折、椎间盘损伤、椎小关节脱位交锁、术前经大重量颅骨牵引不能复位者采用前后路联合复位减压固定融合术。比较三种手术方式的手术时间、术中出血量和平均固定节段数;术后定期复查,观察损伤节段的稳定性和融合率,测量Cobb角、椎体水平移位和Frankel评分表,评估脊髓功能恢复与脊柱损伤重建稳定性等情况。[结果]患者获得有效随访,随访时间6~30个月,平均18个月,术后4~6个月均获得良好的骨性融合,均未出现严重并发症。联合入路组手术时间、出血量和平均固定节段数均较单纯前路或后路组长,而后路手术的手术时间、出血量和平均固定节段数明显多于前路手术组(P0.05);除2例术前Frankel分级A级无恢复外,其余患者均有不同程度恢复,脊髓功能平均提高1.2级。所有患者的术前JOA评分和颈椎复位参数较术后均有改善,差异有统计学意义(P0.05)。[结论]采用前路手术、后路手术或前后路联合手术治疗下颈椎骨折脱位并脊髓损伤均能获得不错的治疗效果,但应根据颈椎损伤部位及类型采取适合的手术入路,根据病情制订个性化治疗方案。
[Abstract]:Objective to investigate the clinical effect of different approaches in the treatment of lower cervical fracture and dislocation complicated with spinal cord injury. [methods] from July 2011 to June 2015, 39 patients with lower cervical spine fracture and dislocation complicated with spinal cord injury were treated. There were 5 cases of grade A, 12 cases of grade B, 14 cases of grade C and 8 cases of grade D. According to the type of fracture, the degree of dislocation, the evaluation of spinal cord compression, the existence of articular process fracture and interlocking or anterior and posterior complex injury and other factors to choose the surgical scheme. Among them, 24 cases of vertebral fracture and intervertebral disc injury were treated with anterior decompression and interbody bone grafting and internal fixation through skull traction before operation. 7 cases of cervical dislocation with facet joint fracture or dislocation without obvious anterior and middle column injury were treated with posterior reduction and lateral mass screw internal fixation. Eight cases of cervical vertebral fracture, intervertebral disc injury and interlocking facet joint dislocation were treated with anterior and posterior reduction and decompression and fusion. The operation time, the amount of intraoperative bleeding and the average number of fixed segments were compared among the three methods. After operation, the stability and fusion rate of injured segments were observed, Cobb angle, horizontal displacement of vertebral body and Frankel score table were measured, and the recovery of spinal cord function and the stability of spinal injury reconstruction were evaluated. [results] the patients were followed up effectively for 6 to 30 months, with an average of 18 months, and good bone fusion was obtained at 4 months after operation, and no serious complications occurred. The operation time, bleeding volume and average number of fixed segments in the combined approach group were longer than those in the simple anterior approach or posterior approach, while the operation time, bleeding volume and the average number of fixed segments in the posterior approach group were significantly higher than those in the anterior approach group (P 0.05). Except for 2 cases of Frankel grade A without recovery before operation, all the other patients recovered to varying degrees, and the spinal cord function increased by 1.2 grades on average. The preoperative JOA score and cervical reduction parameters of all patients were improved, the difference was statistically significant (P 0.05). [conclusion] anterior surgery, posterior surgery or anterior and posterior combined surgery can achieve good results in the treatment of lower cervical fracture and dislocation complicated with spinal cord injury, but a suitable surgical approach should be taken according to the location and type of cervical spine injury. Make individualized treatment plan according to the condition.
【作者单位】：暨南大学附属河源医院脊柱外科;暨南大学附属第一医院脊柱外科;
【分类号】：R651.2;R687.3

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