论文部分内容阅读
[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(P＜0.05);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(P＜0.05).[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.“,”[Objective] To investigate the clinical outcomes of different surgical approaches for the treatment of lower cervical spine fracture/dislocation combined with spinal cord injury.[Methods] Thirty-nine patients with cervical spine fracture/dislocation combined with spinal cord injury were treated surgically from July 2011 to June 2015.Preoperative Frankel classification was classified as grade A in 5 cases,B in 12 cases,C in 14 cases,D in 8 cases,respectively.The surgical scheme was selected according to the type of fracture,the degree of dislocation,whether combined with articular process fracture,locked facet and complex injury,or not.For 24 cases with fracture of vertebral body combined with intervertebral disc injury,anterior decompression,intervertebral bone graft fusion and internal fixation was carried out after preoperative skull traction.For 7 cases of cervical dislocation with small joint fracture or dislocation but without obvious anterior/middle column damage,the posterior lateral mass screw fixation was given.In another 8 cases,small joint dislocation and locked facet were combined with fracture,and reduction was not achieved successfully after large weight skull traction,then a combined anterior/posterior approach decompression and fusion was applied.The operation time,intraoperative blood loss,average fixed segment number,as well as postoperative complications were recorded and compared among 3 groups.The Cobb Angle,horizontal displacement of vertebral body and Frankel scale were evaluated to assess the recovery of spinal cord function and stability of spinal injury reconstruction.[Results] All cases were followed up for average of 18 months (range,6 to 30 months).Solid fusion was obtained in all cases within the postoperative 4～6 months.The operation time,blood loss and average fixed vertebrae number in the combination group was much more than the anterior or posterior group,with significant difference (P＜ 0.05),additionally,those in the posterior group was much more than the anterior group,also with significant difference (P＜ 0.05).The Frankel scale was improved by 1.2 grades in average,except 2 cases who had no recovery.Furthermore,JOA score was improved significantly in all cases,with significant difference (P＜0.05).[Conclusions] Anterior approach,posterior approach,or combination of them should be selected for different individuals on the basis of traumatic condition,injury location and different types of cervical spine instability.