下頸椎骨折脫位并脊髓損傷的治療術(shù)式探討
發(fā)布時間：2019-05-17 19:34
【摘要】：[目的]探討不同入路手術(shù)方式治療下頸椎骨折脫位合并脊髓損傷的臨床療效。[方法]2011年7月~2015年6月收治下頸椎骨折脫位合并脊髓損傷患者39例,術(shù)前Frankel分級A級5例,B級12例,C級14例,D級8例。根據(jù)骨折類型、脫位程度、脊髓受壓評估情況、是否存在關(guān)節(jié)突骨折及交鎖或者前后復合體損傷等因素選擇手術(shù)方案。其中24例椎體骨折、椎間盤損傷、術(shù)前經(jīng)顱骨牽引可復位者采用前路減壓椎間植骨內(nèi)固定術(shù);7例頸椎脫位伴小關(guān)節(jié)骨折或脫位但不伴明顯前中柱損傷者采用后路復位側(cè)塊螺釘內(nèi)固定術(shù);8例頸椎椎體骨折、椎間盤損傷、椎小關(guān)節(jié)脫位交鎖、術(shù)前經(jīng)大重量顱骨牽引不能復位者采用前后路聯(lián)合復位減壓固定融合術(shù)。比較三種手術(shù)方式的手術(shù)時間、術(shù)中出血量和平均固定節(jié)段數(shù);術(shù)后定期復查,觀察損傷節(jié)段的穩(wěn)定性和融合率,測量Cobb角、椎體水平移位和Frankel評分表,評估脊髓功能恢復與脊柱損傷重建穩(wěn)定性等情況。[結(jié)果]患者獲得有效隨訪,隨訪時間6~30個月,平均18個月,術(shù)后4~6個月均獲得良好的骨性融合,均未出現(xiàn)嚴重并發(fā)癥。聯(lián)合入路組手術(shù)時間、出血量和平均固定節(jié)段數(shù)均較單純前路或后路組長,而后路手術(shù)的手術(shù)時間、出血量和平均固定節(jié)段數(shù)明顯多于前路手術(shù)組(P0.05);除2例術(shù)前Frankel分級A級無恢復外,其余患者均有不同程度恢復,脊髓功能平均提高1.2級。所有患者的術(shù)前JOA評分和頸椎復位參數(shù)較術(shù)后均有改善,差異有統(tǒng)計學意義(P0.05)。[結(jié)論]采用前路手術(shù)、后路手術(shù)或前后路聯(lián)合手術(shù)治療下頸椎骨折脫位并脊髓損傷均能獲得不錯的治療效果,但應(yīng)根據(jù)頸椎損傷部位及類型采取適合的手術(shù)入路,根據(jù)病情制訂個性化治療方案。
[Abstract]:Objective to investigate the clinical effect of different approaches in the treatment of lower cervical fracture and dislocation complicated with spinal cord injury. [methods] from July 2011 to June 2015, 39 patients with lower cervical spine fracture and dislocation complicated with spinal cord injury were treated. There were 5 cases of grade A, 12 cases of grade B, 14 cases of grade C and 8 cases of grade D. According to the type of fracture, the degree of dislocation, the evaluation of spinal cord compression, the existence of articular process fracture and interlocking or anterior and posterior complex injury and other factors to choose the surgical scheme. Among them, 24 cases of vertebral fracture and intervertebral disc injury were treated with anterior decompression and interbody bone grafting and internal fixation through skull traction before operation. 7 cases of cervical dislocation with facet joint fracture or dislocation without obvious anterior and middle column injury were treated with posterior reduction and lateral mass screw internal fixation. Eight cases of cervical vertebral fracture, intervertebral disc injury and interlocking facet joint dislocation were treated with anterior and posterior reduction and decompression and fusion. The operation time, the amount of intraoperative bleeding and the average number of fixed segments were compared among the three methods. After operation, the stability and fusion rate of injured segments were observed, Cobb angle, horizontal displacement of vertebral body and Frankel score table were measured, and the recovery of spinal cord function and the stability of spinal injury reconstruction were evaluated. [results] the patients were followed up effectively for 6 to 30 months, with an average of 18 months, and good bone fusion was obtained at 4 months after operation, and no serious complications occurred. The operation time, bleeding volume and average number of fixed segments in the combined approach group were longer than those in the simple anterior approach or posterior approach, while the operation time, bleeding volume and the average number of fixed segments in the posterior approach group were significantly higher than those in the anterior approach group (P 0.05). Except for 2 cases of Frankel grade A without recovery before operation, all the other patients recovered to varying degrees, and the spinal cord function increased by 1.2 grades on average. The preoperative JOA score and cervical reduction parameters of all patients were improved, the difference was statistically significant (P 0.05). [conclusion] anterior surgery, posterior surgery or anterior and posterior combined surgery can achieve good results in the treatment of lower cervical fracture and dislocation complicated with spinal cord injury, but a suitable surgical approach should be taken according to the location and type of cervical spine injury. Make individualized treatment plan according to the condition.
【作者單位】： 暨南大學附屬河源醫(yī)院脊柱外科;暨南大學附屬第一醫(yī)院脊柱外科;
【分類號】：R651.2;R687.3
[Abstract]:Objective to investigate the clinical effect of different approaches in the treatment of lower cervical fracture and dislocation complicated with spinal cord injury. [methods] from July 2011 to June 2015, 39 patients with lower cervical spine fracture and dislocation complicated with spinal cord injury were treated. There were 5 cases of grade A, 12 cases of grade B, 14 cases of grade C and 8 cases of grade D. According to the type of fracture, the degree of dislocation, the evaluation of spinal cord compression, the existence of articular process fracture and interlocking or anterior and posterior complex injury and other factors to choose the surgical scheme. Among them, 24 cases of vertebral fracture and intervertebral disc injury were treated with anterior decompression and interbody bone grafting and internal fixation through skull traction before operation. 7 cases of cervical dislocation with facet joint fracture or dislocation without obvious anterior and middle column injury were treated with posterior reduction and lateral mass screw internal fixation. Eight cases of cervical vertebral fracture, intervertebral disc injury and interlocking facet joint dislocation were treated with anterior and posterior reduction and decompression and fusion. The operation time, the amount of intraoperative bleeding and the average number of fixed segments were compared among the three methods. After operation, the stability and fusion rate of injured segments were observed, Cobb angle, horizontal displacement of vertebral body and Frankel score table were measured, and the recovery of spinal cord function and the stability of spinal injury reconstruction were evaluated. [results] the patients were followed up effectively for 6 to 30 months, with an average of 18 months, and good bone fusion was obtained at 4 months after operation, and no serious complications occurred. The operation time, bleeding volume and average number of fixed segments in the combined approach group were longer than those in the simple anterior approach or posterior approach, while the operation time, bleeding volume and the average number of fixed segments in the posterior approach group were significantly higher than those in the anterior approach group (P 0.05). Except for 2 cases of Frankel grade A without recovery before operation, all the other patients recovered to varying degrees, and the spinal cord function increased by 1.2 grades on average. The preoperative JOA score and cervical reduction parameters of all patients were improved, the difference was statistically significant (P 0.05). [conclusion] anterior surgery, posterior surgery or anterior and posterior combined surgery can achieve good results in the treatment of lower cervical fracture and dislocation complicated with spinal cord injury, but a suitable surgical approach should be taken according to the location and type of cervical spine injury. Make individualized treatment plan according to the condition.
【作者單位】： 暨南大學附屬河源醫(yī)院脊柱外科;暨南大學附屬第一醫(yī)院脊柱外科;
【分類號】：R651.2;R687.3
【相似文獻】
相關(guān)期刊論文 前10條
1 呂勝江;楊志強;郝宗文;李建軍;;前路鈦板固定治療頸椎骨折脫位[J];實用骨科雜志;2006年03期
2 徐榮明;;下頸椎骨折脫位及不穩(wěn)的治療(附15例報告)[J];浙江醫(yī)學;1992年02期
3 栗志輝;下頸椎骨折脫位合并截癱的治療方法探討[J];北華大學學報(自然科學版);2000年02期
4 律德利,馬克仁,張洪戰(zhàn),許家祥,姜鴻志;頸椎骨折脫位合并癱瘓32例[J];中國骨傷;2001年11期
5 王長，
本文編號：2479352
本文鏈接：http://www.sikaile.net/yixuelunwen/waikelunwen/2479352.html
最近更新
教材專著
