华西医学

华西医学

一期后路复位单侧钉棒固定联合前路手术治疗下颈椎骨折脱位伴单侧关节突交锁

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目的探讨一期后路复位单侧钉棒固定联合前路手术治疗下颈椎骨折脱位伴单侧关节突交锁的疗效。方法回顾性分析西南医科大学附属医院脊柱外科 2012 年 6 月—2017 年 3 月采用一期后路复位单侧钉棒固定联合前路手术治疗的 28 例下颈椎骨折脱位伴单侧关节突交锁患者,观察手术前后神经功能恢复情况、椎体水平移位、Cobb 角、椎间隙高度以及手术并发症。结果所有患者术后随访 12~24 个月,平均(18.9±4.7)个月。全部患者术后无大血管、气管、食管、硬脊膜损伤等术中并发症。所有患者切口均Ⅰ/甲级愈合。术后并发症:术后声音嘶哑、吞咽困难 3 例,咽喉部疼痛 8 例,肺部感染 1 例,低钠血症 2 例,经相关对症处理后皆痊愈。术后 X 线片示所有患者的下颈椎骨折脱位均完全矫正。术后所有患者未出现脊髓和(或)神经损伤加重。术后 12 个月所有患者神经功能均获不同程度改善,美国脊髓损伤协会评分:B 级 6 例,转为 C 级 4 例、D 级 2 例;C 级 13 例,转为 D 级 10 例、E 级 3 例;D 级 8 例,均转为 E 级;均较术前提高 1~2 级(P<0.05)。所有患者术后 7 d、12 个月颈椎间隙高度、生理曲度及颈椎稳定性维持良好,较术前明显改善(P<0.05);而术后 7 d、12 个月两次随访结果比较差异无统计学意义(P>0.05)。术后 12 个月日本骨科学会评分结果[(14.6±2.3)分]较术前[(6.8±2.6)分]明显改善,术后改善率为(79.6±18.8)%(P<0.05)。随访期间未见螺钉松动、断裂及移位等并发症发生。结论一期后路复位单侧钉棒固定联合前路手术是治疗下颈椎骨折脱位伴单侧关节突交锁的一种安全、有效的方法。

ObjectiveTo investigate the effect of one-stage posterior reduction single nail and rod fixation combined with the anterior operation on lower cervical fracture-dislocation combined with unilateral locked facet.MethodsA retrospective analysis of 28 patients with lower cervical fracture-dislocation combined with unilateral locked facet who underwent one-stage posterior-anterior approach surgery between June 2012 and March 2017 were conducted. The Cobb angle, vertebral body horizontal displacement, height of intervertebral space, recovery of nerve function and operative complications were observed before and after operation.ResultsAll patients were followed up for 12-24 months, with an average of (18.9±4.7) months. All the patients received good reposition after operation without complications such as large blood vessels, trachea, esophagus, spinal dura mater injury and so on. The incisions healed well in all patients. Postoperative complications: postoperative hoarseness and dysphagia occured in 3 cases, pharynx and larynx pain in 8 cases, pulmonary infection in 1 case, and hyponatremia in 2 cases; all patients recovered after the related symptomatic treatment. Postoperative X-ray showed that all the patients were completely corrected without residual small joint semi dislocation and kyphosis. No spinal cord or nerve injury aggravators occurred after surgery. The neurological function of all patients was improved to different degrees 12 months after operation. American Spinal Cord Injury Association (ASIA) classification showed that, of the 6 cases classified as type B preoperatively, 4 cases turned into type C and 2 cases into type D postoperatively; of the 13 cases classified as type C preoperatively, 10 cases turned into type D and 3 into type E postoperatively; and all the 8 cases classified as type D preoperatively turned into type E postoperatively. The ASIA scores increased by 1-2 levels compared with those before operation (P<0.05). The height of cervical intervertebral space, physiological curvature and cervical stability of all patients were well maintained 7 days and 12 months after operation, which were significantly improved compared with those before operation (P<0.05). There was no significant difference between the two follow-up visits at 7 days and 12 months after operation. The Japanese Orthopaedic Association score at 12 months after operation (14.6±2.3) was significantly better than that before operation (6.8±2.6), and the average improvement rate was (79.6±18.8)% (P<0.05). No complications such as screw loosening, fracture or displacement occurred during follow-up.ConclusionOne-stage posterior reduction single nail and rod fixation combined with the anterior operation is safe and effective for the treatment of lower cervical fracture-dislocation combined with unilateral locked facet.

关键词: 颈椎; 骨折脱位; 单钉棒固定; 单侧关节突交锁

Key words: Cervical vertebra; Fracture-dislocation; Single nail and rod fixation; Unilateral locked facet

引用本文: 李汶, 杨函, 王松, 王清, 康建平. 一期后路复位单侧钉棒固定联合前路手术治疗下颈椎骨折脱位伴单侧关节突交锁. 华西医学, 2018, 33(9): 1085-1089. doi: 10.7507/1002-0179.201808042 复制

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