一期后—前路联合手术治疗下颈椎骨折脱位疗效分析
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摘要
目的：报告我科19例严重下颈椎骨折脱位(Fracture and dislocation of lower cervical spine FDLCS)并脊髓损伤的病例,评价对其采取的手术方法对患者病情预后的影响；探讨一期后-前路联合手术治疗下颈椎骨折脱位的可行性,加深对下颈椎骨折脱位并脊髓损伤的认识。
方法：采用回顾性研究方法对我科自2006年10月至2008年10月间收入的下颈椎骨折脱位并脊髓损伤的25例中病例资料较完整的19例患者进行研究,对本组病例的手术方式以及手术对患者预后的影响进行了临床分析。术前患者均诊断为下颈椎并脊髓损伤,适合并要求行手术治疗,入院后均接受常规正侧位X线检查,采用多层螺旋CT及MRI扫描颈椎。分别于术前及术后对其进行了随访,平均随访22.4月。临床效果以脊髓损伤Frankel分级(附表一)及改良JOA评分标准(附表二)进行综合评价。
结果：随访时间14到32月,平均22.4月。颈椎摄片复查提示所有患者颈椎骨折脱位获得复位,颈椎椎体序列及生理曲度基本得到恢复；术后6个月内植骨融合；无钛板和螺钉松动、移位或断裂。颈部疼痛和上下肢症状消失或基本缓解。脊髓损伤按Frankel功能分级有不同程度恢复,只有1例A级患者及1例B级患者Frankel功能分级无明显改善,秩和检验,P<0.05,有统计学意义。根据改良JOA评分术前平均(7.68±2.56)分,随访时平均(10.89±3.53)分,术前和随访时比较差异有统计学意义(配对t检验,P<0.01)
结论：对于下颈椎骨折脱位并颈髓损伤,脊髓前后方均受到压迫时,一期后-前路联合手术能达到充分减压、稳定脊柱、为脊髓功能恢复创造有利条件。
Object:To report 19 cases of fracture and dislocation of lower cervical spine in our department. Evaluate the prognosis of patients who are treated by surgical methods, Explore the treatment and surgery strategies for fracture and dislocation of lower cervical spine combined with spinal cord injury, deepen the understanding of fracture and dislocation of lower cervical spine.
Materials and Methods:To summarize the clinical features of 19 patients with comparatively integrated materials of 25 fracture and dislocation of lower cervical spine combined with Cervical spinal cord injury from October 2006 to October 2008 in our department, using a retrospective study method, Analysis the treatment, surgery strategies and the influence on the prognosis of patients after operation. All patients are diagnosed with fracture and dislocation of lower cervical spine combined with cervical spinal cord injury before operation, and are fit for and require for surgical treatment. All are examined conventionally by positive-side x-rays, multislice CT and MRI. Assess the clinical effect on the Frankel classification standards of spinal cord and improved JOA assessment standards.
Results:The patients were followed up from 14 months to 32 months (average22.4 months).Cervical spine X-ray film prompted a review of all patients with cervical spine fracture and dislocation was reset, the cervical vertebrae sequence and physiological curvature were restored. The bones were fused in 6 months. There were no loosing or migration of a screw or plate, or failure of hardware. Neck and cervicobrachial pain had been cured or greatly improved. Cervical spinal cord injury improved to different degrees according to the Frankel classification standards of spinal cord。Only one case in A, and B do not get any improved. Rank-sum test shows the statistically significant P＜0.05. Improved JOA score is (7.68±2.56) on average preoperatively, and(10.89±3.53) on average postoperatively after follow-up. The difference between before and after operation has the statistically significant (paired t-test, P＜0.01).
Conclusions:For patients who has fracture and dislocation of lower cervical spine combined with spinal cord injury, one stage combined posterior-anterior procedure is an essential, safe and effective method for decompression of spinal cord and immediately stability of spine and optimizes the environment for maximum spinal cord function recover when radiographs demonstrate the cervical spinal cord is compressed from both anterior and posterior directions.
方法：采用回顾性研究方法对我科自2006年10月至2008年10月间收入的下颈椎骨折脱位并脊髓损伤的25例中病例资料较完整的19例患者进行研究,对本组病例的手术方式以及手术对患者预后的影响进行了临床分析。术前患者均诊断为下颈椎并脊髓损伤,适合并要求行手术治疗,入院后均接受常规正侧位X线检查,采用多层螺旋CT及MRI扫描颈椎。分别于术前及术后对其进行了随访,平均随访22.4月。临床效果以脊髓损伤Frankel分级(附表一)及改良JOA评分标准(附表二)进行综合评价。
结果：随访时间14到32月,平均22.4月。颈椎摄片复查提示所有患者颈椎骨折脱位获得复位,颈椎椎体序列及生理曲度基本得到恢复；术后6个月内植骨融合；无钛板和螺钉松动、移位或断裂。颈部疼痛和上下肢症状消失或基本缓解。脊髓损伤按Frankel功能分级有不同程度恢复,只有1例A级患者及1例B级患者Frankel功能分级无明显改善,秩和检验,P<0.05,有统计学意义。根据改良JOA评分术前平均(7.68±2.56)分,随访时平均(10.89±3.53)分,术前和随访时比较差异有统计学意义(配对t检验,P<0.01)
结论：对于下颈椎骨折脱位并颈髓损伤,脊髓前后方均受到压迫时,一期后-前路联合手术能达到充分减压、稳定脊柱、为脊髓功能恢复创造有利条件。
Object:To report 19 cases of fracture and dislocation of lower cervical spine in our department. Evaluate the prognosis of patients who are treated by surgical methods, Explore the treatment and surgery strategies for fracture and dislocation of lower cervical spine combined with spinal cord injury, deepen the understanding of fracture and dislocation of lower cervical spine.
Materials and Methods:To summarize the clinical features of 19 patients with comparatively integrated materials of 25 fracture and dislocation of lower cervical spine combined with Cervical spinal cord injury from October 2006 to October 2008 in our department, using a retrospective study method, Analysis the treatment, surgery strategies and the influence on the prognosis of patients after operation. All patients are diagnosed with fracture and dislocation of lower cervical spine combined with cervical spinal cord injury before operation, and are fit for and require for surgical treatment. All are examined conventionally by positive-side x-rays, multislice CT and MRI. Assess the clinical effect on the Frankel classification standards of spinal cord and improved JOA assessment standards.
Results:The patients were followed up from 14 months to 32 months (average22.4 months).Cervical spine X-ray film prompted a review of all patients with cervical spine fracture and dislocation was reset, the cervical vertebrae sequence and physiological curvature were restored. The bones were fused in 6 months. There were no loosing or migration of a screw or plate, or failure of hardware. Neck and cervicobrachial pain had been cured or greatly improved. Cervical spinal cord injury improved to different degrees according to the Frankel classification standards of spinal cord。Only one case in A, and B do not get any improved. Rank-sum test shows the statistically significant P＜0.05. Improved JOA score is (7.68±2.56) on average preoperatively, and(10.89±3.53) on average postoperatively after follow-up. The difference between before and after operation has the statistically significant (paired t-test, P＜0.01).
Conclusions:For patients who has fracture and dislocation of lower cervical spine combined with spinal cord injury, one stage combined posterior-anterior procedure is an essential, safe and effective method for decompression of spinal cord and immediately stability of spine and optimizes the environment for maximum spinal cord function recover when radiographs demonstrate the cervical spinal cord is compressed from both anterior and posterior directions.
引文
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