下颈椎骨折合并关节突交锁的手术策略
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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(P<0.05).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 zygapophyseal joints dislocation reduction,and the recovery of neurological deficit is very satisfying due to effective spinal canal decompression.
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(P<0.05).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 zygapophyseal joints dislocation reduction,and the recovery of neurological deficit is very satisfying due to effective spinal canal decompression.
引文
[1]Koivikko MP,Myllynen P,Santavirta S.Fracture dislocations of the cervical spine:a review of 106conservatively and operatively treated patients[J].Eur Spine J,2004,13(7):610-616.
[2]张庆林,李江,纪军,等.下颈椎骨折脱位的手术治疗方法探讨[J].实用骨科杂志,2010,16(5):329-332.
[3]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):838-845.
[4]Allen BL Jr,Ferguson RL,Lehmann TR,et al.A mechanistic classification of closed,indirect fractures and dislocations of the lower cervical spine[J].Spine(Phila Pa 1976),1982,7(1):1-27.
[5]Dvorak MF,Fisher CG,Fehlings MG,et al.The surgical approach to subaxial cervical spine injuries:an evidence-based algorithm based on the SLIC classification system.[J].Spine(Phila Pa 1976),2007,32(23):2620-2629.
[6]曲延镇,罗政,郭晓东,等.硬脊膜或脊髓切开减压治疗脊髓损伤后广泛水肿伴或不伴髓内血肿[J].中华骨科杂志,2015,35(7):707-713.
[7]张宏其.颈椎骨折与脱位治疗的几点思考[J].中华创伤杂志,2014,30(8):759-761.
[8]蓝旭,许建中,罗飞,等.不同入路手术治疗下颈椎骨折脱位[J].中华创伤杂志,2013,29(4):302-306.
[9]杨俊,郭新辉,聂军,等.前后联合入路治疗伴有难复位性关节突交锁的颈椎骨折脱位[J].中华创伤骨科杂志,2011,13(12):1199-1200.
[10]姚关锋,王新家,王伟东,等.Halo-vest支架复位联合前路减压内固定治疗下颈椎骨折脱位[J].中华创伤杂志,2015,31(8):695-698.
[11]刘勇,卲川强,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,2015,21(6):481-485.
[12]刘兴国,吕建军,谢威,等.前后路一期治疗下颈椎骨折脱位伴关节突绞锁[J].实用骨科杂志,2009,15(11):835-837.
[13]陈剑明,胡勇,顾勇杰,等.Ⅰ期后-前路联合手术入路治疗下颈椎骨折脱位合并脊髓损伤的疗效分析[J].中国骨伤,2010,23(12):938-941.
[14]张伟,杨博贵,刘爱文.经前后路联合椎弓根钉内固定治疗67例颈椎骨折脱位的疗效评价[J].中国骨与关节损伤杂志,2014,29(7):645-647.
[15]张宏其,向伟能,陈静,等.Ⅰ期前后路联合手术治疗严重下颈椎骨折脱位[J].中国矫形外科杂志,2007,15(10):727-730.
[2]张庆林,李江,纪军,等.下颈椎骨折脱位的手术治疗方法探讨[J].实用骨科杂志,2010,16(5):329-332.
[3]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):838-845.
[4]Allen BL Jr,Ferguson RL,Lehmann TR,et al.A mechanistic classification of closed,indirect fractures and dislocations of the lower cervical spine[J].Spine(Phila Pa 1976),1982,7(1):1-27.
[5]Dvorak MF,Fisher CG,Fehlings MG,et al.The surgical approach to subaxial cervical spine injuries:an evidence-based algorithm based on the SLIC classification system.[J].Spine(Phila Pa 1976),2007,32(23):2620-2629.
[6]曲延镇,罗政,郭晓东,等.硬脊膜或脊髓切开减压治疗脊髓损伤后广泛水肿伴或不伴髓内血肿[J].中华骨科杂志,2015,35(7):707-713.
[7]张宏其.颈椎骨折与脱位治疗的几点思考[J].中华创伤杂志,2014,30(8):759-761.
[8]蓝旭,许建中,罗飞,等.不同入路手术治疗下颈椎骨折脱位[J].中华创伤杂志,2013,29(4):302-306.
[9]杨俊,郭新辉,聂军,等.前后联合入路治疗伴有难复位性关节突交锁的颈椎骨折脱位[J].中华创伤骨科杂志,2011,13(12):1199-1200.
[10]姚关锋,王新家,王伟东,等.Halo-vest支架复位联合前路减压内固定治疗下颈椎骨折脱位[J].中华创伤杂志,2015,31(8):695-698.
[11]刘勇,卲川强,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,2015,21(6):481-485.
[12]刘兴国,吕建军,谢威,等.前后路一期治疗下颈椎骨折脱位伴关节突绞锁[J].实用骨科杂志,2009,15(11):835-837.
[13]陈剑明,胡勇,顾勇杰,等.Ⅰ期后-前路联合手术入路治疗下颈椎骨折脱位合并脊髓损伤的疗效分析[J].中国骨伤,2010,23(12):938-941.
[14]张伟,杨博贵,刘爱文.经前后路联合椎弓根钉内固定治疗67例颈椎骨折脱位的疗效评价[J].中国骨与关节损伤杂志,2014,29(7):645-647.
[15]张宏其,向伟能,陈静,等.Ⅰ期前后路联合手术治疗严重下颈椎骨折脱位[J].中国矫形外科杂志,2007,15(10):727-730.