Objective: To explore the choice of operative approach for old inferior-cervical fracture-dislocation and analyze the clinical effects of anterior operative approach. Methods: From January 2003 to May 2010,17 patients with inferior-cervical fracture-dislocation delayed for more than 4 weeks were treated with continued closed skull traction and anterior decompression, bone graft and internal fixation with steel plate. Among the patients, 11 patients were male and 6 patients were female, with an average age of 41 years (ranged from 24 to 56 years). The time between injury and operation was from 4 weeks to 3 months. According to Frankel grade, grade A was in 7 cases, B in 4, C in 2, D in 2, E in 2. Neurological function, bone fusion, height of vertebral body and cervical sequence and curvature were observed. Results :The incision of 17 cases obtained primary healing. There was 1 case with hoarseness,and symptoms disappeared after 1 month. The mean time of follow-up was 23 months (ranged from 4 to 47 months). The X-ray films showed satisfactory reduction and good alignment and lordosis. The Frankel grade improved obviously at final follow-up,grade A was in 5 cases,B in 5,C in 1 ,D in 3,E in 3. Conclusion:Single anterior operative approach can successfully reduce old inferior-cervical fracture-dislocation of DF stage I , II and some stage Ⅲ ;anterior decompression,bone graft and internal fixation with steel plate is a safe,effective method for old inferior-cervical fracture-dislocation.%目的:探讨陈旧性下颈椎骨折脱位的手术入路选择以及前路手术治疗的治疗效果.方法:2003年1月至2010年5月,l7例下颈椎骨折脱位患者因不同原因于伤后4周以上行持续颅骨牵引和前路减压植骨钢板内固定术.其中男11例,女6例;年龄24～56岁,平均41岁;受伤至手术时间4周～3个月.Frankel分级:A级7例,B级4例,C级2例,D级2例,E级2例.评价治疗前后的神经功能,观察术后植骨融合情况、椎间高度和颈椎椎体序列.结果:17例患者切口均Ⅰ期愈合.1例出现声音晰哑,1个月后症状消失.平均随访23个月(4～47个月),术后X线示椎间隙高度和颈椎序列恢复满意,内固定物和植骨稳定无松动,融合满意.术后Frankel分级明显改善,A级5例,B级5例,C级1例,D级3例,E级3例.结论:单纯前路手术可以使屈曲牵引型(DF)Ⅰ、Ⅱ型和部分Ⅲ型复位,对陈旧性下颈椎骨折脱位的患者采用前路减压植骨钢板内固定术是一种有效、简便、安全的方法.
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