摘要
目的探讨一期前后路联合手术治疗下位颈椎严重骨折脱位手术方法及临床疗效。方法1999年8月～2008年2月对119例下颈椎严重骨折脱位一期前路行椎间盘或椎体次全切除减压植骨钛板内固定融合，同时行后路复位椎弓根内固定术。术前应用图像存储传输系统（以下简称PACS），采用x线片及64排CT片对下位颈椎椎弓根的冠状位、矢状位、横断位进行精确测量，得出椎弓根的宽度、高度、向内侧倾斜、向尾侧倾斜角度、螺钉直径及长度数据值。术中根据术前测得的数据值，应用颈椎椎弓根定位导向器打孔、置钉、固定。结果定期复查，观察损伤节段的稳定性和融合率，采用ASIA分级判定脊髓功能的恢复情况，98例获得随访，时间18—72个月，平均24．7个月。获得随访的患者，骨折脱位均完全复位，损伤节段稳定，颈椎椎体高度和生理曲度维持良好，融合率为100％，内固定位置良好，无植骨块脱出或钢板螺钉松动、断裂等并发症，脊髓功能评价平均提高1．15级，22例术后神经症状无变化。结论一期前后路联合手术治疗下颈椎骨折脱位，可获得满意的复位、彻底的减压和即刻三维稳定性的重建，有利于脊髓功能的恢复．临床疗效满意．是一种可行的方法。
Objective To investigate the clinical effectiveness and feasibility of one-stage operation in combination with anterior and posterior approach to treat the severe fracture and dislocation of the low cervical spine.Methods One hundred and nineteen patients with severe fracture and dislocation of the low cervical spine were treated by one-stage operation in combination with anterior intervertebral disc eetomied or vertebral body subtotal ectomied decompression bone grafting fusion and posterior pedicel screw fixator reposition approach from August 1999 to June 2008. The picture archiving and communication systems（PACS） were used preoperatively. X-ray and 64- slice Helical CT film was used to accurately measure the axial, coronal and sagittal pedicle of vertebral arch of the lower cervical vertebra, to acquire the width, height , angle of inclination in entad and caudal ward of pedicle of vertebral arch, diameter and length of screw . The location guider of pedicle of vertebral arch of cervical was used to perforate, put screw and fix.Results The stability and fusion of the injured segments were observed through periodic check. The spinal function was evaluated with ASIA classification. Ninty-eight patients were followed up from 18 to72 months （mean 24.7 months）. All cases got completely reduction.The injured segments were stable. The intervertebral height and lordosis maintained satisfying and the rate of fusion was 100%. The internal fixation position was well. There was no complication of bone grafting extrusion and loosening or broken of plate or screws. The function of spinal cord was improved by 1.15 grade.The nerves symptom of twenty-two patients did not change postoperatively. Conclusion The satisfactory reposition and complete decompression and immediately three dimensional stability can be achieved in the treatment of the fracture and dislocation of severe low cervical spine through the anterior and posterior approaches. This technique is beneficial to patients for functional recovery of spinal cord and the clinical effectiveness is satisfactory.
出处
《中国骨与关节损伤杂志》
2010年第3期193-195,共3页
Chinese Journal of Bone and Joint Injury
关键词
下颈椎
椎弓根钉
前后入路
骨折脱位
内固定术
Lower cervical vetebrae
Cervical pedicle
Anterior and posterior approach
Fracture and dislocation
Internal fixation
