Objective To investigate the outcome of the patients with fracture and dislocation of lower cervical spine via different approach. Methods From December 2002 to January 2012,16 patients with fracture and dislocation of lower cervical spine underwent anterior,posterior or combined approach,which was combined with vertebral cannal decompression,bone grafting and internal fixation. The classification of Frankel were as follows:3 at grade A,5 at grade B,3 at grade C,3 at grade D,and 2 at grade E. Results There was no injury of blood vessel or recurrent nerve during the surgery and no incision infection,leakage of cerebrospinaUherniation of bone graft and internal fixation failure postoperatively in any of these patients. The fracture and dislocation of lower cervical spine was corrected and height of vertebral body recovered in all patients. The follow-up period was range 12~24 months. The Cobb angle was averaged 10° before operation and decreased to 2° at final follow-up. Bony fusion was obtained 3~6 months postoperatively. The nerve function of the spinal cord recovered at different degrees:3 at grade A, 1 at grade B, 1 at grade C, 2 at grade D, and 5 at grade E. Conclusion Anterior approach can be used to remove the injuried disc directly and handle instability of cervical spine immediately and posterior approach can be used to settle dislocation and interlocking of lesser joint,but intervertebral disc injury must be ruled out simultaneously in order to avoid further injury of spinal cord during the reduction process. Combined approach can solve the dislocation and intervertebral disc injury at the same time,however,higher risk and more operative injury should be considered. Flexible and reasonable operative approach should be adopted to treat fracture and dislocation of lower cervical spine.%目的 探讨根据颈椎骨折脱位类型采用不同人路的手术疗效.方法 2002-12-2012-01对16例下颈椎骨折脱位伴颈髓损伤的患者分别采用前方入路、后方入路和前后联合入路行椎管减压植骨融合内固定术,术前Frankel分级:A级3例,B级5例,C级3例,D级3例,E级2例.结果 术中无大血管或喉返神经损伤等并发症,术后无切口感染、脑脊液漏、植骨块脱出和内固定断裂塌陷等并发症.术后随访12～24个月,本组下颈椎骨折脱位均得到纠正,颈椎椎体高度完全恢复,术前Cobb角平均为10°,末次随访为2°.本组植骨3～6个月均获得骨性愈合,术后Frankel分级:A级3例,B级1例,C级1例,D级2例,E级5例.结论 前路手术可以直接处理椎间盘损伤并即刻消除颈椎不稳；后路手术可以直接解除关节突脱位绞锁,但需排除颈椎间盘损伤以避免复位时加重脊髓损伤；前后联合入路可以同时处理颈椎骨折脱位和椎间盘损伤,但手术创伤和风险较大.应根据下颈椎骨折脱位不同伤情采取合理手术方式.
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