颈椎过伸性损伤的手术治疗

摘要

Objective To evaluate the methods and efficacy of operative treatment of cervical hyperextensioninjury.Methods 83 cases of cervical hyperextension injury were retrospectively analyzed from January 2012 to June 2015.There were 63 males and 20 females,aged 25 ～ 78 years,average 58.5 years old.All patients were accompanied by spinal cord nerve lesions.According to Frankel classification,grade A accounted for 4 cases,grade B accounted for 18 cases,grade C accounted for 32 cases and grade D accounted for 29 cases.All patients underwent surgical treatment.72 cases were treated with anterior disectomy or eorpectomy,bone grafting andplate fixation.11 cases weretreated with posterior decompression with laminoplasty andlateral mass screws or pedicle screws fixation.Results All of them were followedup for 9 to 18 months.All bone grafts fused,no failure of internal fixations was found.Preoperative and postoperative Frankel classifications and ASIA(American Spinal Injury Association)grades were compared between the two groups.The neural function improved significantly between the two groups after operation.The average of Frankel class increased by 1～2 grade.ASIA score increased by (26.2±5.4) among anterior group(P =0.019),and increased by (15.2 ±6.1) in the posterior group(P =0.036).Cases underwentanterior approach had significantly better result in neural function than the posterior approach group(P＜0.05).Conclusion It's preferred to choose anterior decompression with bone grafting and internal fixation as the surgical choice to treat cervical hyperextensioninjury.The posterior surgery also result in an effective outcome,which could be a supplement to the anterior surgery.%目的 探讨颈椎过伸性损伤手术治疗方法的选择及疗效.方法 2012年1月至2015年6月收治颈椎过伸性损伤患者83例,其中男63例,女20例;年龄25～78岁,平均58.5岁.所有患者均伴有脊髓神经损伤,按Frankel 分级,A级4例,B级18例,C级32例,D级29例.所有患者均行手术治疗,其中72例行颈前路减压植骨融合钢板内固定术,11例行颈后路减压椎板成形术+侧块螺钉/椎弓根螺钉内固定术.结果 所有患者经9～18个月随访,均获得骨性融合,无内固定失败;比较两组手术前、后的Frankel分级变化和ASIA评分改变.两组术后脊髓功能均较术前有明显改善;Frankel分级平均提高1～2级,前路组ASIA评分增加(26.2±5.4)分(P=0.019),后路组ASIA评分增加(15.2±6.1)分(P=0.036);前路减压、植骨内固定较后路减压、内固定术后神经功能恢复好,差异有统计学意义(P＜0.05).结论 前路减压植骨融合内固定是治疗过伸性颈椎损伤首选手术方式,后路手术同样有效,是前路手术的有效补充.