摘要
目的探讨过屈型颈椎损伤并发前部脊髓综合征的不同手术治疗方式并评价其疗效。方法收集2015年1月至2017年4月于河北省唐山市第二医院治疗的过屈型颈椎损伤并发前部脊髓综合征39例患者的病历资料。所有患者根据不同病情分别采取不同手术治疗方式,观察术前及术后1年随访日本骨科协会评分变化以评价疗效。结果对于单纯前脱位经颅骨牵引复位后能够稳定的,或无骨折脱位但有椎间盘损伤突出的患者,选择颈椎前路手术,摘除损伤的椎间盘,取自体髂骨或椎间融合器植骨,行蝶形钢板内固定术。对于椎体骨折患者,经颅骨牵引复位稳定后选用经前路伤椎次全切除,取自体髂骨或钛网植骨,行蝶形钢板内固定术。对于合并关节突关节骨折、椎板骨折或小关节嵌顿无法经牵引复位或复位后仍不稳定患者,选择联合后路切开复位椎板减压侧块钢板或椎弓根钉棒系统内固定术。对于合并黄韧带肥厚、后纵韧带骨化或存在发育性椎管狭窄的患者,选择前路手术同时联合相应的后路手术。所有患者随访期间骨折脱位均经手术复位固定效果满意,均无感染、内固定失败等严重并发症。39例患者术后1年随访日本骨科协会总分明显高于术前[(6.02±1.45)分比(2.74±0.58)分],差异有统计学意义(P<0.05)。结论对于过屈型颈椎损伤并前部脊髓综合征的患者,应根据受伤机制、影像学病理特征及临床症状的不同,有针对性地选择合理的手术方法,可使患者获得理想预后。
Objective To observe the therapeutic effect of different surgical treatments on cervical hyperflexion injury with anterior spinal cord syndrome.Methods Clinical records of 39 cases of cervical hyperflexion injury with anterior spinal cord syndrome in the Second Hospital of Tangshan were collected from January 2015 to April 2017.The patients were treated with different surgical methods according to individual conditions.Japanese Orthopedics Association （JOA） score was observed before and 1 year after operation to evaluate the surgical effect.Results Patients with simple anterior dislocation after cranial traction reduction and patients with intervertebral disc injury without fracture dislocation were treated with anterior cervical surgery to remove the injured disc;autogenous iliac bone or interbody fusion apparatus was used for internal fixation.Patients with vertebral fracture were treated with cranial traction and anterior subtotal vertebral body resection;autogenous iliac bone or titanium mesh was used for internal fixation.For patients with facet joint fracture,vertebral plate fracture or facet incarceration that can not be treated with traction reduction,combined posterior open reduction and laminectomy decompression,lateral plate or pedicle screw internal fixation were optional operation choice.Patients with hypertrophy of ligamentum flavum,ossification of posterior longitudinal ligament or developmental spinal stenosis should have combined anterior and posterior approach surgery.All fractures and dislocations recovered well after surgery;no serious complications such as infection and internal fixation failure was observed during follow-up.In 39 patients,the total score of JOA at 1-year after surgery was significantly higher than that before surgery[（6.02 ± 1.45） vs （2.74 ±0.58）] （P 〈0.05）.Conclusion Surgical strategy of cervical hyperflexion injury with anterior spinal cord syndrome should be chosen according to the injury type,imaging features and clinical manifestations;patients will
作者
张艳
魏威
张洪梅
李谷
李建华
张军军
关维俊
Zhang Yan;Wei Wei;Zhang Hongmei;Li Gu;Li Jianhna;Zhang Junjun;Guan Weijun(President Office,the Second Hospital of Tangshan,Hebei Province,Tangshan 063000,Chin;Department of Orthopedics,Tangshan People＇s Hospital,Hebei Province,Tangshan 063000,Chin;Clinical Medical College,North China University of Science and Technology,Hebei Province,Tangshan 063000,China;Nursing Service Center,the Second Hospital of Tangshan,Hebei Province,Tangshan 063000,Chin;Operation Room,the Second Hospital of Tangshan,Hebei Province,Tangshan 063000,Chin;the Third Spinal Department,the Second Hospital of Tangshan,Hebei Province,Tangshan 063000,China;School of Public Health,North China University of Science and Technology,Hebei Province,Tangshan 063000,China)
出处
《中国医药》
2018年第9期1385-1388,共4页
China Medicine
基金
国家卫生和计划生育委员会公益性行业科研专项(201402021)~~
关键词
过屈型颈椎损伤
前部脊髓综合征
骨科手术
预后评价
Cervical hyperflexion injury
Anterior spinal cord syndrome
Orthopedic surgery
Prognosis evaluation
