伴关节突交锁的下颈椎骨折脱位的手术策略

摘要

Objective To investigate the operation strategy of anterior approach and one-stage posterior-anterior ap-proach in the treatment of subaxial cervical fracture-dislocation with locked-facet.Methods 68 cases of lower cerci-cal fracture-dislocation with locked-faced were managed in our institution,which were all dealed with surgery.There were unilateral locked facet in 23 cases,bilateral facet locked in 45 cases.Closed reduction was attempted in all pa-tients by skull traction.40 patients were achieved reduction successfully and anterior cervical fixation operations were performed (Group A).One-satge posterior-anterior approach operations were performed in the other 28 patients who could not achieve reduction (Group B).Results Successful rate of closed reduction in all paitients was 58.8%.No one with spinal cord injury were aggravated after operation.The neurological fuction of 12 patients with complete spi-nal cord inury were not improved at all.The average sense and motion score of American Spinal Cord Injury Associa-tion (ASIA)neurological function scale were apperantly improved up to 1 ~2 levels at final follow-up when comparing with preoperative scores (P <0.05).There was no statistical difference between group A and group B in the recovery rate (P >0.05).X-ray films were examined disconnectedly on the third day after operation,and the 3rd,6th,12th months.Kyphosis (Cobb angle),vertebral body translation,vertebral body height and interbody fusion were almost normal and no looseness or breakage was detected in the fixation system in all patients.Conclusions Anterior ap-proach can be used to remove the injuried disc directly and handle instable cervical spine immediately.Combined ap-proach can solve the dislocation and intervertebral disc injury at the same time,individualized operation scheme should be formulated according to the type of injury.%目的：探讨前路和一期后前路联合手术治疗下颈椎骨折脱位伴关节突交锁的手术策略。方法手术治疗68例下颈椎骨折脱位伴关节突交锁患者，其中单侧关节突交锁23例，双侧关节突交锁45例。所有患者先行持续闭合颅骨牵引复位，分为复位成功前路手术组（A 组，40例）和复位失败后前后路联合手术组（B 组，28例）。结果68例复位成功率58．8％，双侧交锁较单侧交锁复位成功率高。术后患者无脊髓损伤，12例完全性脊髓损伤者无恢复。ASIA 评分平均提高1～2级，牵引后感觉评分增加，末次随访感觉、运动评分均显著增加，与术前比较差异有统计学意义（P ＜0．05）。两组间评分比较差异无统计学意义（P ＞0．05），所有患者术后3 d 及术后3、6、12个月定期行 X 线检查显示椎体序列及椎间高度良好，植骨正常融合，无内置物松动、断裂等并发症。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；前后联合入路可以同时处理颈椎骨折脱位和椎间盘损伤，需根据患者损伤类型，制定个体化的手术方案。