摘要
目的探讨后路椎间盘镜(MED)通道下解除关节突关节交锁联合前路椎管减压融合内固定术治疗单侧关节突关节交锁难复性下颈椎骨折脱位的可行性及临床疗效。方法选取2016年3月至2019年2月于本院行后路MED通道下解除关节突关节交锁联合前路椎管减压融合内固定术治疗的13例单侧关节突关节交锁难复性下颈椎骨折脱位患者作为研究对象,术前均完善X线、三维CT、MRI等检查,记录患者手术时间、出血量,观察手术前后损伤节段椎体脱位复位、术后神经功能恢复、植骨融合等情况,评估手术疗效。结果13例患者均顺利完成手术,椎体间脱位均完全复位,术中无脊髓神经损伤等并发症发生;手术时间为160~260min,平均(205±45)min;术中出血量为30~310ml,平均(120±75)ml;术后均获随访,随访时间6~28个月,平均(14±6)个月;2例美国脊髓损伤协会(ASIA)A级患者中,1例术后恢复至ASIAB级,1例恢复至ASIAC级,2例ASIAB级患者恢复至ASIAD级,2例ASIAC级患者改善至ASIAD级,3例ASIAD级患者均完全恢复,4例ASIAE级患者无加重;椎体间植骨在8个月内牢固融合(平均6个月),内固定无松动,椎间序列良好。结论后路MED通道下解除关节突关节交锁联合前路椎管减压融合内固定术治疗单侧关节突关节交锁难复性下颈椎骨折脱位疗效显著,可明显减少手术创伤,生物力学稳定,值得临床推广应用。
Objective To investigate the viability and clinical efficacy of posterior microendoscopic discectomy(MED)to unilateral facet joint combined with anterior canal decompression and fusion internal fixation for irreducible lower cervical fracture with unilateral facet joint interlock.Methods 13 patients who underwent posterior MED channel release of posterior microendoscopic discectomy to unilateral facet joint combined with anterior canal decompression and fusion internal fixation in our hospital from March 2016 to February 2019 were selected as the research subjects,Xray,threedimensional CT,MRI and other examinations were performed before surgery to record the operative time and blood loss of patients,the dislocations of injured vertebrae before and after the operation were observed,nerve function recovery after the operation,bone graft fusion and other conditions were evaluated.Results All the 13 patients successfully completed the operation,and the intervertebral dislocation was completely restored,no complications such as spinal nerve injury occurred during the operation;the operative time was 160-260 min,with an average of(205±45)min;intraoperative blood loss was 30-310 ml,with an average of(120±75)ml;all patients were followed up after surgery,and the follow-up time was 6-28 months,with an average of(14±6)months;among 2 cases American Spinal Injuries Association(ASIA)grade A patients,1 cases recovered to ASIA grade B after operation,1 cases recovered to ASIA C,2 cases ASIA grade B patients recovered to ASIA grade D,2 cases ASIA grade C patients improved to ASIA grade D,and 3 cases ASIA grade D patients recovered completely,there were no exacerbations in 4 cases ASIA grade E patients;the intervertebral bone graft was firmly fused within 8 months(mean 6 months),with no loosening of internal fixation and good intervertebral sequence.Conclusion Posterior MED to unilateral facet joint combined with anterior canal decompression and fusion internal fixation is an effective method for the treatment of irreducible l
作者
陈勤
伍耀宏
丁毅
陈荣春
刘宁
CHEN Qin;WU Yaohong;DING Yi;CHEN Rongchun;LIU Ning(Department of Spine Surgery,Ganzhou People's Hospital,Ganzhou,Jiangxi,341000,China)
出处
《当代医学》
2023年第3期11-15,共5页
Contemporary Medicine
基金
江西省卫健委计划项目(20177240)。
关键词
下颈椎骨折脱位
关节突关节交锁
椎间盘镜通道
侧块钉
颈椎后路
Lower cervical fracture
Facet joint interlock
Microendoscopic discectomy
Screw for lateral cervical mass
Posterior cervical approach
