摘要
[目的]探讨单纯颈椎前路手术治疗伴关节突交锁的下颈椎脱位的治疗效果及可行性。[方法]回顾性分析2016年12月~2018年6月手术治疗伴关节突交锁的下颈椎脱位患者32例。按手术方式,20例行单纯前入路手术,12例行前后联合入路手术。记录围手术期资料,采用脊髓功能Frankel评分和JOA评分评价临床效果。拍摄X线片,评价复位和固定情况及术后椎间融合情况。[结果]两组患者均顺利手术,术中均无神经、血管、食管及硬脊膜损伤。单纯前路组的手术时间、术中出血量和术后引流量均显著小于前后路联合组(P<0.05)。两组术中透视次数的差异无统计学意义(P>0.05)。单纯前路组术后切口均愈合良好,未见感染。前后路联合组术后发生切口感染2例,经换药及清创处理后切口均愈合。两组术后均未出现心脑血管等不良事件。两组患者随访12~18个月,Frankel分级随术后时间推移而改善,不同时间点差异均有统计学意义(P<0.05);相应时间点,两组间Fankel分级的差异无统计学意义(P>0.05)。术后6个月时两组患者的JOA评分均较术前显著增加(P<0.05);但相同时间点,两组间JOA评分的差异均无统计学意义(P>0.05)。术中C型臂X线机透视下观察单纯前路组复位率为93.75%,前后路联合组为100%;在术后3个月时两组的植骨融合率分别为90.63%和93.75%;在术后6个月时两组损伤节段均达到骨性融合。[结论]单纯颈椎前路手术治疗伴关节突交锁的下颈椎脱位,多数情况下可复位成功,且手术安全性较好,远期融合率较高。
[Objective] To explore the efficacy and feasibility of mere anterior reduction and instrumented fusion for lower cervical spine fracture dislocation accompanied with facet locking. [Methods] A retrospective study was done on 32 patients who underwent surgical treatment for lower cervical spine fracture dislocation accompanied with facet locking from December2016 to June 2018. According to surgical procedure conducted, 20 patients had anterior reduction and instrumented fusion only,while the remaining patients had anterior surgery combined with posterior procedure. The perioperative data was documented,whereas the Frankel grading, JOA score and radiographic examination were used for evaluation of the clinical outcomes. [Results] The patients in both groups received successful operations without serious complication, such as iatrogenic injuries to nerve, blood vessel, esophagus and dural sac in anyone of them. The anterior group consumed significantly shorter operation time, associated with significantly less intraoperative blood loss and postoperative drainage than the anteroposterior group(P<0.05), despite of no a statistically significant difference in intraoperative fluoroscopy frequency between them(P>0.05). All patients in the anterior group got primary incision healing with no infection, whereas 2 patients in the anteroposterior group suffered from superficial incision infection, which cured by local debridement and dressing change. During the follow-up period ranged from 12 to 18 months, the Frankel grade for neurological function improved over time in both groups with significant differences among any time points(P<0.05), nevertheless no a statistically significant difference between the two group was proved at any matching time point(P>0.05). The JOA score at 6 months postoperatively significantly increased in both groups compared with those before operation(P<0.05), despite of no a significant difference in JOA score between the two groups at any responding time point(P>0.05). The intraoperative fluoroscopy revealed that the reduction ratio was of 93.75% in the anterior group, while 100% in the anteroposterior group. The bony fusion achieved in 90.63% of the anterior group and 93.75% of anteroposterior groupt 3 months postoperatively, whereas in all the patients of both groups at 6 months postoperatively. [Conclusion] The mere anterior reduction and instrumented fusion achieves satisfactory reduction in most cases for treatment of lower cervical dislocation accompanied with facet locking, and takes benefits of minimizing iatrogenic trauma, as well as high feasibility, safety and fusion rate.
作者
宋宇
田纪伟
SONG Yu;TIAN Ji-wei(Department of Orthopedics,Nanjing Jiangbei People's Hospital Affiliated to Nantong University,Nanjing 210048,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第24期2209-2213,共5页
Orthopedic Journal of China
关键词
颈椎脱位
关节突交锁
颈前路手术
cervical vertebrae dislocation
facet locking
anterior fixation reduction theory
