不同术式治疗下颈椎骨折脱位伴脊髓损伤

摘要

目的：探讨下颈椎骨折伴脊髓损伤的术式选择和临床疗效。方法2008年1月至2011年1月我科收治下颈椎骨折伴脊髓损伤患者96例，其中男67例，女29例；年龄18～50岁，平均33.6岁；依据伤情按手术方式非随机分组，分为前后路组给予前路或后路减压、前后路固定手术治疗；单纯前路组给予前路减压及固定；单纯后路组给予后路减压及固定，观察疗效。术前Frankel分级A级12例，B级17例，C级27例，D级32例，E级8例。结果所有患者随访6～24个月，平均15个月，植骨均在术后4.2个月达到临床愈合，术中无血管、神经、食管、硬脊膜损伤。术后无假关节、骨不连、骨吸收发生，无内固定断裂、松动及脱出。90例（93%）患者术后获得完全复位，术后Frankel分级平均提高1～2级，3组患者术前及术后末次随访神经功能评分比较（ P<0.05），差异有统计学意义。结论前后路联合手术对低位颈椎骨折脱位伴脊髓损伤的患者能更好的充分减压、坚强固定，为脊髓恢复创造条件，值得临床推广。但手术时间相对延长，手术风险会增大，应根据患者具体伤情慎重选择手术方式。%Objective To investigate clinical effects of different surgical treatment of the fracture and dislocation of lower cervical spine combined spinal cord injury. Methods 96 patients with fracture and dislocation of lower cervical spine com-bined spinal cord injury were non-randomly grouped according to operation method from January 2008 to January 2011. The na-tients were divided into anterior or posterior approach decompression and anterior-posterior internal fixation group,anterior de-compression and internal fixation group,posterior decompression and internal fixation group. Preoperative Frankel grade were A in 12 cases,B in 17 cases,C in 27 cases,D in 32 cases,E in 8 cases. Results All patients were followed up for 6 ~24 months,the average period was 15 months. There were no vessels,nerve,esophagus,dura injury. Fusion achieved in all cases at an average of 4. 2 months postoperatively. There were no pseudarthrosis,bone nonunion,bone resorption and no internal fixation breakage,loosening or displacement. The dislocation of 90 cases( 93%)patients was corrected,1 ~2 degree of neurofunction recovery was achieved in all cases. Nerve function of three groups were statistical difference between preoperation and postoper-ation(P<0. 05). Conclusion In the lower cervical spine fracture and dislocation combined with spinal cord injury treat-ment,combined anterior and posterior approach operation can obtain good reduction and rigid internal fixation. This techniQue create the conditions for the functional recovery of the spinal cord,is worth popularization in clinical. But operation time will be extended and the risks increase,we shoud carefully choose surgical options according to patients conditions.