下颈椎骨折脱位合并急性脊髓损伤的手术方式选择及疗效对比
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摘要
目的:分析不同手术方式处理下颈椎骨折脱位合并急性脊髓损伤疗效。方法:选取2012年10月-2015年10月本院收治的110例下颈椎骨折脱位合并急性脊髓损伤患者作为研究对象。A组36例实施前路手术,B组44例实施后路手术,C组30例实施前后路联合手术。比较三种手术方式的治疗效果。结果:术后12个月,三组患者Cobb角、椎体水平位移距离均较术前显著改善(P<0.05),C组患者改善程度显著高于A、B组(P<0.05);C组患者JOA评分优良率显著高于A、B组(P<0.05);在术后随访过程中,三组患者并发症总发生情况无统计学差异(P>0.05)。结论:前后路联合手术治疗可更好地恢复颈椎解剖结构,促进脊髓神经功能恢复,值得在临床工作中进行推广。
Objective: To analyze the clinical effect of three different surgical approaches on the treatment of lower cervical vertebra fracture and dislocation combined with acute spinal cord injury. Methods: 110 patients with lower cervical vertebra fracture and dislocation combined with acute spinal cord injury who were treated in our hospital from October 2012 to October 2015 were selected and randomly divided into three groups. 36 patients in group A were treated with anterior surgery, 44 patients in group B were treated with posterior surgery, and 30 cases in group C were treated with anterior combined posterior operation. Then the clinical effects of different methods were observed and compared. Results: After operation, the Cobb angle and the horizontal displacement distance of the three groups significantly improved(P<0.05). The improvement of group C was significantly higher than that of group A and group B(P<0.05). The JOA score of group C was significantly higher than that of group A and group B(P <0.05). The total incidence of complications had no significant difference among the three groups(P>0.05). Conclusion: Anterior and posterior combined surgical treatment jas better effect on the restoring the anatomical structure of cervical spine and promoting the recovery of spinal nerve function,which is worthy of clinical promotion.
Objective: To analyze the clinical effect of three different surgical approaches on the treatment of lower cervical vertebra fracture and dislocation combined with acute spinal cord injury. Methods: 110 patients with lower cervical vertebra fracture and dislocation combined with acute spinal cord injury who were treated in our hospital from October 2012 to October 2015 were selected and randomly divided into three groups. 36 patients in group A were treated with anterior surgery, 44 patients in group B were treated with posterior surgery, and 30 cases in group C were treated with anterior combined posterior operation. Then the clinical effects of different methods were observed and compared. Results: After operation, the Cobb angle and the horizontal displacement distance of the three groups significantly improved(P<0.05). The improvement of group C was significantly higher than that of group A and group B(P<0.05). The JOA score of group C was significantly higher than that of group A and group B(P <0.05). The total incidence of complications had no significant difference among the three groups(P>0.05). Conclusion: Anterior and posterior combined surgical treatment jas better effect on the restoring the anatomical structure of cervical spine and promoting the recovery of spinal nerve function,which is worthy of clinical promotion.
引文
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[12]费国策,许立新.颈椎前路钛网植骨联合带锁钢板固定治疗下颈椎骨折的临床疗效观察[J].生物骨科材料与临床研究,2015,12(4):46-48Fei Guo-ce,Xu Li-xin.Clinical efficacy of anterior titanium mesh cage and locking plate in treatment of lower cervical spine fracture[J].Orthopaedic Biomechanics Materials and Clinical Study,2015,12(4):46-48
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[14]孙志波,禹志宏,孙晨,等.一期后前路手术治疗下颈椎骨折脱位伴关节突绞锁[J].创伤外科杂志,2014,(3):233-235Sun Zhi-bo,Yu Zhi-hong,Sun Chen,et al.Treatment of lower cervical fracture dislocation and articular process interlocking by one-stage anteroposterior approach[J].Journal of Traumatic Surgery,2014,(3):233-235
[15]贺永雄,刘斌,邢文华,等.单纯后路颈椎椎弓根钉棒系统内固定治疗下颈椎骨折脱位[J].中华创伤骨科杂志,2011,13(4):378-380He Yong-xiong,Liu Bin,Xing Wen-hua,et al.Simple posterior internal fixation with cervical pedicle screws to treat lower fracture and dislocation of cervical spine[J].Chinese Journal of Orthopaedic Trauma,2011,13(4):378-380
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[17]刘加元,李业成,刘守正,等.Ⅰ期局麻后前路联合手术治疗下颈椎骨折脱位伴关节突绞锁[J].创伤外科杂志,2014,16(2):160Liu Jia-yuan,Li Ye-cheng,Liu Shou-cheng,et al.Treatment of lower cervical spinal fracture and dislocation combined with articular process interlocking by one-stage operation via the combined posterior and anterior approaches[J].Journal of Traumatic Surgery,2014,16(2):160
[18]王锋,龙耀武,赵晓东,等.下颈椎骨折脱位并小关节绞锁的外科治疗方法探讨[J].颈腰痛杂志,2013,34(3):185-188Wang Feng,Long Yao-wei,Zhao Xiao-dong,et al.Surgical treatment for lower cervical fracture and dislocation combined with locked facet[J].The Journal of Cervicodynia And Lumbodynia,2013,34(3):185-188
[19]祁敏,王新伟,刘洋,等.三种颈前路减压术式治疗多节段脊髓型颈椎病的并发症比较[J].中国脊柱脊髓杂志,2012,22(11):963-968Qi Min,Wang Xin-wei,Liu Yang,et al.Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy[J].Chinese Journal of Spine and Spinal Cord,2012,22(11):963-968
[20]章波,唐龙,杨波,等.多节段脊髓型颈椎病的手术治疗:三种手术方法的初期临床疗效比较[J].中国矫形外科杂志,2015,23(1):5-11Zhang Bo,Tang Long,Yang Bo,et al.Surgical treatment for multilevel cervical spondylotic myelopathy:the early outcomes of three different surgical approaches[J].Orthopedic Journal of China,2015,23(1):5-11
[2]张国强,鲁世保,杨林,等.颈椎后路复位CPSS内固定治疗下颈椎骨折脱位伴关节突绞锁的临床效果分析[J].现代生物医学进展,2016,16(1):110-112,44Zhang Guo-qiang,Lu Shi-bao,Yang Lin,et al.Clinical Effect of Posterior Cervical Lateral Reduction and CPSS Internal Fixation on Lower Cervical Fractures and Dislocations Combined with Articular Process Interlocking[J].Progress in Modern Biomedicine,2016,16(1):110-112,44
[3]王雷,柳超,田纪伟,等.下颈椎骨折脱位的治疗术式选择[J].中国脊柱脊髓杂志,2013,23(7):610-616Wang Lei,Liu Chao,Tian Ji-wei,et al.Surgical option of lower cervical spine fracture and dislocation[J].Chinese Journal of Spine and Spinal Cord,2013,23(7):610-616
[4]郭琰,周方,田耘,等.下颈椎骨折脱位术式选择及疗效分析[J].中华创伤杂志,2015,31(3):232-235Guo Yan,Zhou Fang,Tian Yun,et al.Methods and therapeutic effects in surgical treatment for lower cervical spine fracture and dislocation[J].Chinese Journal of Trauma,2015,31(3):232-235
[5]贺宝荣,许正伟,郝定均,等.下颈椎骨折脱位并脊髓损伤的前路手术治疗[J].中国脊柱脊髓杂志,2013,23(7):606-609He Bao-rong,Xu Zheng-wei,Hao Ding-jun,et al.Anterior approach for lower cervical spine fractures and dislocations combined with spinal cord injury[J].Chinese Journal of Spine and Spinal Cord,2013,23(7):606-609
[6]段春岳,胡建中,王锡阳,等.早期后-前路Ⅰ期手术治疗严重新鲜下颈椎骨折脱位[J].中南大学学报(医学版),2016,41(8):838-845Duan Chun-yue,Hu Jian-zhong,Wang Xi-yang,et al.Early and one-stage posterior-anterior surgery for fresh and severe lower cervical spine fracture and dislocation[J].Journal of Central South University(Medical Science),2016,41(8):838-845
[7]刘勇,张国华,兰天亮,等.治疗下颈椎骨折脱位伴脊髓损伤的三种手术方式[J].中国矫形外科杂志,2015,23(16):1461-1464Liu Yong,Zhang Guo-hua,Lan Tian-liang,et al.Three different surgical approaches in the treatment of fracture and dislocation of the lower cervical spine combined spinal cord injury[J].Orthopedic Journal of China,2015,23(16):1461-1464
[8]刘勇,邵川强,陈长春,等.不同术式治疗下颈椎骨折脱位伴脊髓损伤[J].实用骨科杂志,2015,(6):481-485Liu Yong,Shao Chuan-qiang,Chen Chang-chong,et al.Clinical Research of Different Surgical Treatment of Fracture and Dislocation of Lower Cervical Spine Combined Spinal Cord Injury[J].Journal of Practical Orthopaedics,2015,(6):481-485
[9]王忻,赵毅,祁学强,等.前后联合入路手术对颈椎骨折合并脊髓损伤患者近期神经功能影响研究[J].河北医药,2016,38(14):2146-2148Wang Xin,Zhao Yi,Qi Xue-qiang,et al.Effects of combined anterior and posterior approach on short-term neurological function in patients with cervical spine fracture complicated by spinal cord injury[J].Hebei Medical Journal,2016,38(14):2146-2148
[10]张树臣.颈前路带锁钢板联合自体植骨治疗颈椎骨折的效果观察[J].世界最新医学信息文摘(连续型电子期刊),2014,(33):9-10Zhang Shu-chen.Anterior cervical locking plate observed treatment effect of body bone fracture combined since[J].World Latest Medicine Information,2014,(33):9-10
[11]李鹏,雪原,王沛,等.后前入路治疗下颈椎骨折脱位伴双侧关节突绞锁[J].中华骨科杂志,2011,31(1):34-38Li Peng,Xue Yuan,Wang Pei,et al.Decompression via posterioranterior approach and anterior fixation in treatment of fracturedislocation of the lower cervical spine with bilateral facet joints dislocation[J].Chinese Journal of Orthopaedics,2011,31(1):34-38
[12]费国策,许立新.颈椎前路钛网植骨联合带锁钢板固定治疗下颈椎骨折的临床疗效观察[J].生物骨科材料与临床研究,2015,12(4):46-48Fei Guo-ce,Xu Li-xin.Clinical efficacy of anterior titanium mesh cage and locking plate in treatment of lower cervical spine fracture[J].Orthopaedic Biomechanics Materials and Clinical Study,2015,12(4):46-48
[13]吴占勇,王少锋,魏运栋,等.经椎旁肌入路复位联合前路手术治疗下颈椎骨折脱位[J].中国脊柱脊髓杂志,2012,22(10):954-956Wu Zhan-yong,Wang Shao-feng,Wei Yun-dong,et al.Combined anterior and posterior approaches for subaxial cervical vertebrae fracture-dislocation plus facet joint interlocking[J].Chinese Journal of Spine and Spinal Cord,2012,22(10):954-956
[14]孙志波,禹志宏,孙晨,等.一期后前路手术治疗下颈椎骨折脱位伴关节突绞锁[J].创伤外科杂志,2014,(3):233-235Sun Zhi-bo,Yu Zhi-hong,Sun Chen,et al.Treatment of lower cervical fracture dislocation and articular process interlocking by one-stage anteroposterior approach[J].Journal of Traumatic Surgery,2014,(3):233-235
[15]贺永雄,刘斌,邢文华,等.单纯后路颈椎椎弓根钉棒系统内固定治疗下颈椎骨折脱位[J].中华创伤骨科杂志,2011,13(4):378-380He Yong-xiong,Liu Bin,Xing Wen-hua,et al.Simple posterior internal fixation with cervical pedicle screws to treat lower fracture and dislocation of cervical spine[J].Chinese Journal of Orthopaedic Trauma,2011,13(4):378-380
[16]郎昭,田伟,袁强,等.术中即时三维导航引导经皮微创椎弓根螺钉内固定治疗颈椎骨折的临床研究[J].中华外科杂志,2015,53(10):752-756Lang Zhao,Tian Wei,Yuan Qiang,et al.Percutaneous minimally invasive pedicle screw fixation for cervical fracture using intraoperative three-dimensional fluoroscopy-based navigation[J].Chinese Journal of Surgery,2015,53(10):752-756
[17]刘加元,李业成,刘守正,等.Ⅰ期局麻后前路联合手术治疗下颈椎骨折脱位伴关节突绞锁[J].创伤外科杂志,2014,16(2):160Liu Jia-yuan,Li Ye-cheng,Liu Shou-cheng,et al.Treatment of lower cervical spinal fracture and dislocation combined with articular process interlocking by one-stage operation via the combined posterior and anterior approaches[J].Journal of Traumatic Surgery,2014,16(2):160
[18]王锋,龙耀武,赵晓东,等.下颈椎骨折脱位并小关节绞锁的外科治疗方法探讨[J].颈腰痛杂志,2013,34(3):185-188Wang Feng,Long Yao-wei,Zhao Xiao-dong,et al.Surgical treatment for lower cervical fracture and dislocation combined with locked facet[J].The Journal of Cervicodynia And Lumbodynia,2013,34(3):185-188
[19]祁敏,王新伟,刘洋,等.三种颈前路减压术式治疗多节段脊髓型颈椎病的并发症比较[J].中国脊柱脊髓杂志,2012,22(11):963-968Qi Min,Wang Xin-wei,Liu Yang,et al.Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy[J].Chinese Journal of Spine and Spinal Cord,2012,22(11):963-968
[20]章波,唐龙,杨波,等.多节段脊髓型颈椎病的手术治疗:三种手术方法的初期临床疗效比较[J].中国矫形外科杂志,2015,23(1):5-11Zhang Bo,Tang Long,Yang Bo,et al.Surgical treatment for multilevel cervical spondylotic myelopathy:the early outcomes of three different surgical approaches[J].Orthopedic Journal of China,2015,23(1):5-11