CAJ | 학술논문

目的探讨后前路减压、前路固定治疗下颈椎骨折脱位伴双侧关节突绞锁的可行性及临床效果.方法 2000年3月至2008年5月,手术治疗下颈椎骨折脱位伴双侧关节突绞锁37例.男21例,女16例;年龄19-58岁,平均42岁.颈椎屈曲牵张(distraction-flexion stage,DFS)损伤3型24例,4型13例.所有患者术前均行X线、CT及MR检查.用后前路手术减压解除绞锁,然后复位、前路融合并行锁定钛板内固定术治疗.以美国国立急性脊髓损伤研究组(NASCIS)和国际截瘫学会(IMSOP)1990年推荐的脊髓损伤神经定位标准,判断颈椎脊髓损伤的平面.ASIA分级判断脊髓恢复情况.术后每个月摄X线片和CT扫描观察复位及植骨融合情况,骨融合后每半年摄片一次.结果手术时间为(4.5±0.5)h,术中出血200～500ml(平均360ml),切口均一期愈合.术后所有患者均恢复颈椎椎体的正常序列.相邻节段固定为23例,跨节段固定13例,1例为四节段固定.术后随访16～45个月,平均32个月.术后X线及CT检查示植骨均在4-8个月内融合,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.术后患者无脊髓损伤加重和ASIA分级的下降,感觉恢复7～20(平均12.7)个平面,脊髓功能平均提高一级.结论后前路减压、解除绞锁,前路融合、钛板内固定手术是治疗下颈椎骨折脱位伴双侧关节突绞锁的一种有效方法,有利于保留脊髓功能.
목적 탐토후전로감압、전로고정치료하경추골절탈위반쌍측관절돌교쇄적가행성급림상효과.방법 2000년3월지2008년5월,수술치료하경추골절탈위반쌍측관절돌교쇄37례.남21례,녀16례;년령19-58세,평균42세.경추굴곡견장(distraction-flexion stage,DFS)손상3형24례,4형13례.소유환자술전균행X선、CT급MR검사.용후전로수술감압해제교쇄,연후복위、전로융합병행쇄정태판내고정술치료.이미국국립급성척수손상연구조(NASCIS)화국제절탄학회(IMSOP)1990년추천적척수손상신경정위표준,판단경추척수손상적평면.ASIA분급판단척수회복정황.술후매개월섭X선편화CT소묘관찰복위급식골융합정황,골융합후매반년섭편일차.결과 수술시간위(4.5±0.5)h,술중출혈200～500ml(평균360ml),절구균일기유합.술후소유환자균회복경추추체적정상서렬.상린절단고정위23례,과절단고정13례,1례위사절단고정.술후수방16～45개월,평균32개월.술후X선급CT검사시식골균재4-8개월내융합,내고정위치량호,무식골괴탈출혹강판、라정송동、단렬등병발증.술후환자무척수손상가중화ASIA분급적하강,감각회복7～20(평균12.7)개평면,척수공능평균제고일급.결론 후전로감압、해제교쇄,전로융합、태판내고정수술시치료하경추골절탈위반쌍측관절돌교쇄적일충유효방법,유리우보류척수공능.
Objective To evaluate the surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of the lower cervical spine with bilateral facet joints dislocation. Methods This study retrospectively reviewed 37 cases of lower cervical spine fracture with bilateral joints dislocation. There were 21 males and 16 females with an average age of 42 years (19-58). Distraction-flexion stage 3(DFS 3) were found in 24 cases and DFS 4 in 13 cases. All the cases were diagnosed by X-ray, CT and MRI and confirmed during the surgery. Decompression via posterior-anterior approach and anterior fixation had been adapted as the surgical strategy. The NASCIS and IMSOP standard were applied to definite the level of cervical spinal cord injury. The ASIA grading was used for evaluation the spinal cord function and the recovery rate. The X-ray and CT were used to observe reduction and bone fusion. Results The mean operative time was (4.5:±0.5) h, and the mean amount of blood loss was 360 ml (200-500 ml). All the incision healed. The two segments fixation was used in 23 cases, 3 segments fixation in 13 cases, and 4 segments fixation in 1 case. The mean follow-up period was 32 months (16-45 months).Postoperative X-ray and CT showed that bone fusion was achieved in all patients within 4-8 months, without graft displacement, or failure of implants. Spinal cord function did not aggravate, and sensory recovery ranged from 7 to 20 levels (averaged, 12.7). The ASIA grade were improved with an average of one grade. Conclusion To treat fracture-dislocation of the lower cervical spine with bilateral facet joints dislocation, the posterlor-anterior approach and anterior fixation/fusion was benefit to preservation the cervical spinal cord function and reconstruction biomechanical stability of the cervical spine.