华西医学

华西医学

单侧颈椎侧块骨折的分型及临床意义

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目的探讨单侧下颈椎(C3-7)侧块骨折的分型及临床意义。方法纳入 2008 年 1 月—2017 年 12 月在西南医科大学附属医院治疗的单侧下颈椎侧块骨折患者 68 例。根据骨折部位分为关节突骨折(A 型)、关节突间部骨折(B 型)和侧块粉碎骨折(C 型)。关节突骨折再分为 2 个亚型:关节突骨折无移位或轻微移位,无椎间孔狭窄(A1 型);关节突骨折移位导致椎间孔狭窄(A2 型)。A1 型根据椎间盘-韧带损伤情况采用单节段颈前路椎间盘切除椎间融合内固定术(anterior cervical disectomy and fusion,ACDF)/颈前路椎体次全切除椎间融合内固定术(anterior cervical corpectomy and fusion,ACCF)或保守治疗;A2 型采用后路手术减压固定融合,或后路减压+前方 ACDF 手术;B 型采用前路单节段 ACDF 手术;C 型采用前路双节段 ACDF/ACCF 手术或后路手术。结果A1 型 35 例,采用前路单节段 ACDF 手术 31 例,ACCF 手术 2 例,保守治疗 2 例(其中 1 例发生迟发性颈椎不稳接受前路 ACDF 手术);A2 型 7 例,采用后路椎间孔减压、椎弓根螺钉固定融合 4 例,前路单节段 ACDF+后路椎间孔减压 2 例,前路单节段 ACDF+后路椎间孔减压+侧块螺钉固定 1 例;B 型 5 例,采用前路单节段 ACDF 手术;C 型 21 例,采用前路双节段 ACDF 手术 14 例,ACCF 手术 6 例,后路椎弓根螺钉固定+单开门椎管扩大成形术 1 例。术后出现 C5 神经根麻痹 1 例,颈椎前方切口血肿 2 例,肺部感染 3 例,无切口感染及神经损害加重病例。62 例(91.2%)患者获得随访,平均随访 14 个月,全部患者获得骨性融合,无内固定失败、后凸畸形等现象。结论单侧下颈椎侧块骨折根据骨折部位及 CT 表现可分为 A1 型、A2 型、B 型和 C 型,根据不同类型选择不同的治疗,可获满意临床效果。

ObjectiveTo investigate the classification and clinical value of unilateral cervical lateral mass fracture (C3-7).MethodsFrom January 2008 to December 2017, 68 patients with unilateral cervical lateral mass fracture who had received treatment in Affiliated Hospital of Southwest Medical University, were included. According to the position of fracture, the fractures were classified into three types: articular process fractures (type A), isthmus fracture (type B), and comminution (type C). Two subtypes of articular process fractures were type A1 and type A2. Type A1 refered to articular process fracture with no or slight displacement. Type A2 refered to articular process fractures result in foraminal stenosis and nerve root compression. Single-level anterior cervical disectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) or conservative treatment was used in type A1. Posterior decompression, fixation and fusion or the method of posterior decompression associated with ACDF were suited to A2. Single-level ACDF was used in type B as well. Type C underwent two-level ACDF or ACCF or posterior procedure.ResultsThere were 35 cases of Type A1, of which 31 patients underwent single-level ACDF, 2 patients underwent ACCF, and 2 patients received conservative treatment, but one of the two underwent ACDF due to delayed cervical instability. Among the 7 cases of type A2, 4 underwent posterior foraminal decompression and posterior fusion with pedicure screw fixation, 2 underwent single-level ACDF and posterior decompression, and 1 underwent single section ACDF and posterior decompression combined with pedical screw fixation. Type C accounted for 21 cases of all targets. Fourteen performed two-level ACDF, 6 performed ACCF, and 1 performed posterior fixation with pedicure screw and expansive open-door laminoplasty. Six patients showed postoperative complications, including C5 root palsy in one case, incision hematoma in two and pulmonary infection in three. There were no case with incision infection or aggravating nervous injury. Sixty-two patients (91.2%) were followed up with a mean duration of 14 months. All the patients obtained bony fusion and no internal fixation failure or kyphosis was found.ConclusionsAccording to fracture position and CT, the unilateral cervical lateral mass fracture can be classified as type A1, type A2, type B, and type C. A satisfied clinical result can be obtained when choosing an appropriate treatment in accordance with different fracture types.

关键词: 颈椎; 侧块骨折; 分型; 手术治疗

Key words: Cervical spine; Lateral mass fracture; Classification; Operation

引用本文: 徐双, 王高举, 杨进, 王清. 单侧颈椎侧块骨折的分型及临床意义. 华西医学, 2018, 33(9): 1079-1084. doi: 10.7507/1002-0179.201808091 复制

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