摘要
目的:探讨手术治疗下颈椎骨折脱位伴关节突交锁的临床疗效及手术入路的选择。方法:2000年2月至2008年2月手术治疗57例下颈椎骨折脱位伴关节突交锁患者,男45例,女12例;年龄18～73岁,平均39.5岁。致伤原因:交通伤35例,坠落伤17例,压砸伤5例。骨折脱位节段:C3-C44例,C4-C513例,C5-C632例,C6-C78例。骨折脱位类型:单侧小关节脱位32例,双侧小关节脱位25例。神经损害程度按美国脊髓损伤学会(ASIA)评分:A级9例,B级17例,C级19例,D级12例。手术入路:14例前路手术,11例后路手术,32例前后联合手术。结果:所有患者获随访,时间3～26个月,平均11个月。临床效果按神经功能(ASIA)评分:平均提高1～2级。骨折脱位节段完全复位,颈椎序列与曲度恢复正常,无节段性不稳,前路植骨融合均于术后12周获骨性融合。结论:单节段新鲜骨折脱位,颈椎牵引容易复位者或爆裂性骨折、严重成角畸形,选择前路手术;颈椎椎板或关节面骨折,压迫以后方为主或多节段颈椎损伤,选择后路手术;对于脊髓受到前后夹挤性压迫时,宜选择前后联合手术。
Objective：To study the operative methods for fracture and dislocation of lower cervical spine with articular process interlocking. Mehods：From Feb. 2002 to Feb. 2008,57 patients with fracture and dislocation of the lower cervical spine with articular process interlocking were treated by operation involving interior, posterior and combining anterior and posterior approach,of whom there were 45 males and 12 females aged from 18 to 73 years old with average of 39.5 years. There were 35 patients caused by traffic accident, 17 patients by falling injury and 5 patienst by crash injury of heavy object. Injured cervical segment： there were 4 patienst with C3-C4,13 patients with C4-C5,32 patientst with C5-C6 and 8 patients with C6-C7. Fracture types of cervical dislocation： there were 32 patients with unilateral articular interlocking and 25 patients with bilateral articular interlocking. According to ASIA criteria the level of nerve injury was grade A in 9 patients,grade B in 17 patients, grade C in 19 patients and grade D in 12 patients. Operative methods： 14 patients were selected by anterior operation, 11 by posterior operation, and 32 by combining anterior and posterior operation. Results：All patients were followed up for 3 to 26 months averaged 11 months. According to ASIA criteria, all patients improved 1 to 2 grade. Patients with cervical fracture and dislocation recovered completely with normal cervical sequence and cervical curvature. There was no patients with cervical un- stability. Bony fusion were found in the patients with anterior interbody fusion at 12 weeks after operation. Conclusion：The anterior operation was selected when one segment fractures on fresh and dislocation, or the cervical fracture and dislocation were reduction with traction, or the angulation deformity was severe. The posterior operation was selected when the cervical vertebral plate of articular facet fractures and the compression were from posterior, or multi-segment of cervical injured. The combining anterior and posteri
出处
《中国骨伤》
CAS
2009年第8期583-584,共2页
China Journal of Orthopaedics and Traumatology
关键词
颈椎
骨折
脱位
骨折固定术
内
Cervical vertebrae
Fractures
Dislocations
Fracture fixation.internal
