下颈椎骨折脱位伴关节突交锁35例临床治疗分析

摘要

Objective To explore the safe and effective method for the fracture and dislocation of lower cervical spine combined with locked facet. Methods Retrospective analysis was conducted on the clinical data of 35 patients with fracture and dislocation of lower cervical spine combined with locked facet ,who were received from October 2009 to April 2013. The imaging data including X-ray,CT scan and reconstruction,magnetic resonance imaging(MRI) and neurological function assessment of American Spinal Injury Association(ASIA) had been completed before operation. The 35 cases of fracture and dislocation of lower cervical spine combined with locked facet were treated with sustained skull closed traction reduction ,and the early treatment adopted posterior,anterior or combined anterior-posterior decompressive surgery,bone graft fusion and internal fixation with ac-cording to the result of reset. The therapeutic effect was observed. Results 35 patients were successful with closed reduction ,in-cluding increasing the traction weight in 3 cases in the operating room under general anesthesia. The postoperative follow-up of X-ray showed that cervical vertebra sequence and vertebral height obtained good reconstruction and maintenance. ASIA neurological function assessment increased by about 1 or more after treatment. All cases obtained solid fusion within 4-6 months without com-plications like implants loose,fracture and so on. Conclusion The sustained skull closed traction reduction for patients with fracture and dislocation of lower cervical spine combined with locked facet can achieve satisfactory result by posterior ,anterior or combined anterior-posterior decompressive surgery,bone graft fusion and internal fixation according to the result of reset with sat-isfactory effect.%目的：探讨下颈椎骨折脱位伴关节突交锁安全、有效的治疗方法。方法回顾性分析2009年10月至2013年4月35例下颈椎骨折脱位伴关节突交锁患者的临床资料。术前均完善X射线、CT平扫及重建、磁共振成像等影像学资料及美国脊髓损伤协会（ASIA）神经功能评估，对35例下颈椎骨折脱位伴关节突交锁患者行持续颅骨闭合牵引复位，据复位情况早期选择后路、前路或前后联合手术减压、植骨融合、内固定手术治疗，观察治疗效果。结果35例患者均闭合复位成功，其中3例在手术室全身麻醉下加大牵引质量复位成功。术后颈椎即获稳定，术后X射线随访提示：颈椎序列、椎体高度得到良好重建及维持。治疗后ASIA神经功能评级平均约提高1级以上。植骨4~6个月融合，无内置物松脱、断裂等并发症。结论对下颈椎骨折脱位伴关节突交锁患者行持续颅骨闭合牵引，根据复位情况及损伤类型择期选择后路、前路或前后联合手术减压、植骨融合内固定手术，可以获得满意疗效。