下颈椎骨折脱位合并脊髓损伤的手术治疗

下颈椎骨折脱位合并脊髓损伤的手术治疗推荐到首页　□巫洪波姚仕奋谢惠缄陈民江铃波王大城　《中国实用医药》2009年第09期1/4页1234
　　【摘要】目的探讨下颈椎骨折脱位合并脊髓损伤的手术治疗。方法回顾性分析27例下颈椎骨折脱位合并脊髓损伤患者行手术治疗的临床资料,其中颈椎压缩型骨折脱位15例,颈椎爆裂性骨折脱位4例,单侧小关节脱位5例,双侧小关节脱位3例,美国脊髓损伤学会（ASIA）评分:A级5例,B级7例,C级12例,D级3例。13例采用前路手术,8例采用后路手术,6例采用前后联合入路手术。结果术中均无大血管、气管、食道、脊髓意外损伤。术后随访12~36个月,平均18个月。无一例发生钢板、螺钉松动、断裂等并发症。植骨于术后12周均获得骨性融合,无假关节、骨不连发生,90%患者术后获得完全复位,术后颈椎间高度、生理曲度无丢失。完全性脊髓损伤患者术后神经功能均无恢复,但上肢疼痛、麻木有不同程度的缓解。不完全性脊髓患者术后神经功能均有一定恢复,平均ASIA评分提高1~2级。结论根据颈椎损伤的类型采用适合的手术入路手术治疗下颈椎骨折脱位均能达到良好的解剖复位,取得良好的临床疗效。
　　【关键词】颈椎;脱位;外科手术;脊髓损伤
　　
　　TheSurgicaltreatmentoffractureanddislcationoflowercervicalspinecombinedspinalcordinjury
　　WUHong-bo,YAOShi-feng,XIEHui-jiang,etal.OrthopedicDepartment,theAffilatedHuizhouCentralHospitalofGuangdongMedicalCollege,Huizhou,Guangdong516001,China
　　
　　【Abstract】ObjectiveToexplorethesurgicalmethodandclinicaleffectsforthetreatmentoffractureanddislocationoflowercervicalspinecombinedspinalcordinjury.MethodsTheclinicaldataof27patientsoflowercervicalspinefractureanddislocationwereretrospectivelyanalyzed.Therewere15caseswithvertebralbodycompressivefractureanddislocation,4caseswithvertebralbodyburstingfractureanddislocation,5caseswithunilatetalfacetdislocation,3caseswithbilateralfacetdislocation.Allcaseswereassociatedwithspinalcordinjury.AccodingtoAmericanSpinalInjuryAssociation（ASIA）grades,5caseswereinAgrade,7casesinBgrade,12casesinCgradeand3casesinDgrade.Allpatientshadsurgicalreduction,decompression,stabilizationandfusion,inthesecases,anteriorprocedurewasperformedin13,posteriorprocedurein8,combinedanteriorandposteriorprocedurein6.ResultsAllpatientswerefollowedupin12to36months,themeanfollow-uptimewas18months.Therewerenogreatvessels,trachea,esophagusorspinalcordiatrogenicinjury.Therewerenopull-outandbreakageofscrewsorplates.Fusionwasachievedinallpatientsatanaverageof12weekspostoperatively.Therewerenopseudarthrosisofbonenounion.Ofallthepatients,96.3%wereaquiredcompletelyreductionandthenormalintervertebralheightandlordosisweremaintained.Patientswithcompletespinalcordhadnoneurologicrecovery,buttheyfeltrelieffromupperlimbpainornumb.Incompletespinalcordlesionsimprovedonaverage1-2Frankelgradeaftersurgery.ConclusionSurgicaltreatmentofdifferenttypesofcervicalfractureanddislocationcanachiveanefficientandsafeclinicaloutcome,whilereliableselectionofsurgicalprocedureoncarfullyconsideringthepatient’sstatusbeforeoperation.1/4页1234评论（0篇）