摘要
目的探讨下颈椎骨折合并关节突交锁的治疗策略。方法回顾性分析2008年1月至2016年8月在我院行手术治疗的47例下颈椎骨折合并关节突交锁患者,其中男35例,女12例;年龄22～65岁,平均(42.2±10.8)岁。其中19例患者闭合复位后采取了单纯前路减压内固定植骨融合术,其余28例经闭合复位失败后采取了单纯后路切开复位减压内固定植骨融合术。采用美国脊髓损伤学会(American spinal injury association,ASIA)分级评价治疗效果。结果随访12～47个月,平均(21.6±8.6)个月。单纯前路减压内固定植骨融合术的手术时间为(97.8±7.1)min,出血量为(127.5±15.8)mL;单纯后路切开复位减压内固定植骨融合术的手术时间为(127.2±8.6)min,出血量为(412.5±19.5)mL。所有患者的关节交锁在术后均得到满意复位,术后12个月两组患者术后的ASIA分级较术前显著改善(P<0.05)。植骨融合时间为4～9个月,平均(5.8±1.6)个月。随访期间无内固定松动、断裂及移位。结论对下颈椎骨折合并关节突交锁患者而言,若可以闭合复位,实施单纯前路手术可获得良好的减压与稳定效果,若闭合复位失败采取单纯后路切开复位减压固定融合术,不仅有利于关节突交锁复位且术后的神经功能恢复也十分满意。
Objective To explore the surgical strategies for patients of lower cervical spinefracture complicated with zygapophyseal joints dislocation. Methods We retrospectively analyzed 47 cases of lower cervical spine fracture complicated with zygapophyseal joints dislocation,including 35 cases of males and 12 cases of females,from January,2008 to August,2016.Mean ageof the patientswas（42.2±10.8）years（range,22～65 years）.Among them,19 cases underwent simple anterior decompression and internal fixation and bone graft fusion after closed reduction,and the remaining 28 cases were treated with single posterior open reduction decompression internal fixation and bone graft fusion second to the failure of closed reduction.American Spinal Injury Association（ASIA）Grade of neurologic function was used for evaluation of therapeutic effect. Results Mean of follow-up was（21.6±8.6）months（range,12～47 months）.The operation time and amount of bleeding were（97.8±7.1）min and（127.5±15.8）mL,respectively,in the group of simple anterior decompression and internalfixation and bone graft fusion.And the operation time and amount of blood loss were（127.2±8.6）min and（412.5±19.5）mL,separately,in the group ofsingle posterior open reduction decompression internal fixation and bone graft fusion.All facet dislocations achieved satisfactoryreduction after surgery.And ASIA grade in both of the two groups were significantly improved aftersurgery（P0.05）.Mean of bone grafting fusion time（5.8±1.6）months（range,4～9 months）.There was no instrumentation looseness,fracture and displacement during the follow-up.Conclusion For the patients of lower cervical spine fracture complicated with zygapophyseal joints dislocation,once obtained closed reduction,simple anterior decompression and internal fixation and bone graft fusion is enough for decompression and stability reconstruction;once failed for closed reduction,single posterior open reduction decompression fixation and fusion is more suitable to achieve zy
作者
刘军
李伟伟
祁洁
弓立群
范亚一
卫文博
段大鹏
Liu Jun,Li Weiwei ,Qi Jie(First Department of Orthopaedics, People＇s Hospital of Shanxi Province, Xi＇an 710068, Chin)
出处
《实用骨科杂志》
2018年第6期487-490,共4页
Journal of Practical Orthopaedics
关键词
下颈椎骨折
关节突交锁
手术策略
前路
后路
lower cervical spine fracture
zygapophyseal joints dislocation
surgical strategies
anteriorapproach
posteriorapproach
