CAJ | 학술논문

目的观察可调式颈椎牵引器复位颈椎骨折脱位的临床效果.方法回顾性分析2007年9月至2011年11月治疗47例颈椎骨折脱位患者资料,男36例,女11例;年龄7～62岁,平均35岁.伤后到就诊时间0.5～72 h,平均8.6 h.脱位节段:寰枕关节2例,C1.22例,C2.3 5例,C3.42例,C4.59例,C5.6 13例,C6.7 14例;其中30例伴骨折.16例无关节突绞锁,10例为单侧关节突绞锁,21例为双侧关节突绞锁.根据美国脊髓损伤学会(American Spinal Injury Association,ASIA)分级标准,术前A级4例,B级10例,C级18例,D级10例,E级5例.根据日本骨科学会(Japanese Orthopaedic Association,JOA)评分标准,术前JOA评分为2～14分,平均9分.采用可调式颈椎牵引器复位,复位后行支具或内固定治疗.结果 47例患者均成功复位,无一例发生神经损伤加重.牵引重量为7～60 kg,平均25.6 kg;牵引时间为3～10 min,平均8 min.术后随访时间为6～48个月,平均38个月.所有椎体排列、椎间高度均恢复正常;椎体间植骨全部融合,融合时间3～6个月,平均3.3个月;1例椎弓骨折患者术后1年仍未愈合,但无特殊不适,未再处理.末次随访时ASIA分级:A级3例,B级1例,C级4例,D级8例,E级31例;JOA评分为2～17分,平均12分.结论可调式颈椎牵引器使用简便、安全,可实现即时复位,且复位成功率高.
목적 관찰가조식경추견인기복위경추골절탈위적림상효과.방법 회고성분석2007년9월지2011년11월치료47례경추골절탈위환자자료,남36례,녀11례;년령7～62세,평균35세.상후도취진시간0.5～72 h,평균8.6 h.탈위절단:환침관절2례,C1.22례,C2.3 5례,C3.42례,C4.59례,C5.6 13례,C6.7 14례;기중30례반골절.16례무관절돌교쇄,10례위단측관절돌교쇄,21례위쌍측관절돌교쇄.근거미국척수손상학회(American Spinal Injury Association,ASIA)분급표준,술전A급4례,B급10례,C급18례,D급10례,E급5례.근거일본골과학회(Japanese Orthopaedic Association,JOA)평분표준,술전JOA평분위2～14분,평균9분.채용가조식경추견인기복위,복위후행지구혹내고정치료.결과 47례환자균성공복위,무일례발생신경손상가중.견인중량위7～60 kg,평균25.6 kg;견인시간위3～10 min,평균8 min.술후수방시간위6～48개월,평균38개월.소유추체배렬、추간고도균회복정상;추체간식골전부융합,융합시간3～6개월,평균3.3개월;1례추궁골절환자술후1년잉미유합,단무특수불괄,미재처리.말차수방시ASIA분급:A급3례,B급1례,C급4례,D급8례,E급31례;JOA평분위2～17분,평균12분.결론 가조식경추견인기사용간편、안전,가실현즉시복위,차복위성공솔고.
Objective To observe the clinical effects of the adjustive tractor for cervical dislocation.Methods Forty-seven patients were included between September 2007 and November 2011.There were 36 males and 11 females with age ranged from 7 to 62 (mean,35 years).The mean interval from injury to admission was 8.6 h (range,0.5-72 h).There were atlanto-occipital dislocation in 2 cases,C1.2 in 2 cases,C2.3 dislocation in 5 cases,C3.4 dislocation in 2,C4.5 in 9,C5.6 in 13,C6.7 in 14.Thirty cases were complicated by fracture.No facet locking occurred in sixteen cases.Facet locking was found in ten cases and bilateral facet locking was in 21 cases.After reduction,brace or internal fixation followed.According to American Spinal Injury Association (ASIA) spinal function impairment scale standard,there were 4 cases in level A,10 cases in level B,18 in C,10 in D,and 5 in E.According to Japanese Orthopaedic Association (JOA) spinal function rating standard,the mean JOA score was 9 (range,2-14).Results All 47 cases were reduced successfully without neuronal function aggravation.Traction power ranged from 7 to 60 kg (mean,25.6 kg),the mean time of traction was 8 min (range,3-10 min).The mean follow-up was 38 (range,6-48) months.All the patients achieved normal alignment and intervertebral height.The intervertebral body fusion was observed in all of cases,the mean fusion time was 3.3 months (range,3-6 months).One patient who experienced nonunion of vertebral arch fracture didn't receive further treatment because of absence of symptoms.At last follow-up,there were 3 cases in level A,1 in level B,4 in C,8 in D,and 31 in E according to ASIA scale.The mean JOA score was 12 (range,2-17).Conclusion The adjustive tractor is simple and safe for prompt reduction.