中国脊柱脊髓杂志
中國脊柱脊髓雜誌
중국척주척수잡지
CHINESE JOURNAL OF SPINE AND SPINAL CORD
2009年
12期
904-908
,共5页
下颈椎%陈旧性脱位%手术治疗
下頸椎%陳舊性脫位%手術治療
하경추%진구성탈위%수술치료
Low cervical spine%Old dislocation%Operation
目的:探讨下颈椎陈旧性脱位的手术治疗方法及近期疗效.方法:2004年6月～2008年2月收治下颈椎陈旧性脱位患者23例,脱化椎体为C4 4例,C5 5例,C6 10例,C7 4例,均为前脱位.神经功能按ASIA分级,A级2例,B级1例,C级5例,D级8例,E级7例.入院后均行颅骨牵引.根据术前测量的颈椎中矢状位CT二维重建图像上脱位节段最小椎管矢状径与椎体前后径比值(C/V比值)及关节突关节的绞锁情况制定手术方案,15例0.5≤C/V比值<0.9的患者中,6例无关节绞锁患者直接行前路松解、复位植骨融合术,9例合并关节绞锁患者先行全身麻醉后透视下颅骨牵引复位术,3例复位成功后行前路植骨融合术,余6例闭合复位失败(仍存在关节绞锁)的患者先行后路复位固定再行前路植骨融合术;5例合并关节绞锁且0.3<C/V比值<0.5的患者先行前路松解、减压,再行后路复位固定,最后行前路植骨融合术;3例合并关节绞锁且C/V比值≤0.3的患者,先前路松解,再行后路全椎板切除减压、复位,最后行前路减压、植骨融合术.采用颈椎功能残障指数(NDI)、VAS评分及ASIA分级评价颈部功能、疼痛稃度及神经功能.结果:平均手术时间105min,术中平均出血量280ml,术中无脊髓、血管、神经损伤,平均住院时间15.7d.术后并发切口脂肪液化1例,内固定松动1例.20例患者随访15～48个月,平均28个月,脱位节段的C/V比值由术前0.56±0.27增至术后0.86±0.07(P<0.05),术后6个月为0.88±0.06,与术后比较无显著性差异(P>0.05);术后3、6、12个月NDI、VAS评分分别较术前平均下降24%、2.4分,26%、2.8分,35%,3.3分;术后6个月所有患者植骨均融合;术后12个月时10例患者的神经功能至少改善1个ASIA评分等级,余3例(A级、B级和D级各1例)无明显改善.结论:根据术前测量的颈椎中矢状位CT二维重建图像上脱位节段椎管最狭窄处的C/V比值及关节突关节的绞锁情况制定手术方案,治疗下颈椎陈旧性脱位能够恢复脱位节段的椎管容积,重建下颈椎的稳定性,近期疗效满意.
目的:探討下頸椎陳舊性脫位的手術治療方法及近期療效.方法:2004年6月～2008年2月收治下頸椎陳舊性脫位患者23例,脫化椎體為C4 4例,C5 5例,C6 10例,C7 4例,均為前脫位.神經功能按ASIA分級,A級2例,B級1例,C級5例,D級8例,E級7例.入院後均行顱骨牽引.根據術前測量的頸椎中矢狀位CT二維重建圖像上脫位節段最小椎管矢狀徑與椎體前後徑比值(C/V比值)及關節突關節的絞鎖情況製定手術方案,15例0.5≤C/V比值<0.9的患者中,6例無關節絞鎖患者直接行前路鬆解、複位植骨融閤術,9例閤併關節絞鎖患者先行全身痳醉後透視下顱骨牽引複位術,3例複位成功後行前路植骨融閤術,餘6例閉閤複位失敗(仍存在關節絞鎖)的患者先行後路複位固定再行前路植骨融閤術;5例閤併關節絞鎖且0.3<C/V比值<0.5的患者先行前路鬆解、減壓,再行後路複位固定,最後行前路植骨融閤術;3例閤併關節絞鎖且C/V比值≤0.3的患者,先前路鬆解,再行後路全椎闆切除減壓、複位,最後行前路減壓、植骨融閤術.採用頸椎功能殘障指數(NDI)、VAS評分及ASIA分級評價頸部功能、疼痛稃度及神經功能.結果:平均手術時間105min,術中平均齣血量280ml,術中無脊髓、血管、神經損傷,平均住院時間15.7d.術後併髮切口脂肪液化1例,內固定鬆動1例.20例患者隨訪15～48箇月,平均28箇月,脫位節段的C/V比值由術前0.56±0.27增至術後0.86±0.07(P<0.05),術後6箇月為0.88±0.06,與術後比較無顯著性差異(P>0.05);術後3、6、12箇月NDI、VAS評分分彆較術前平均下降24%、2.4分,26%、2.8分,35%,3.3分;術後6箇月所有患者植骨均融閤;術後12箇月時10例患者的神經功能至少改善1箇ASIA評分等級,餘3例(A級、B級和D級各1例)無明顯改善.結論:根據術前測量的頸椎中矢狀位CT二維重建圖像上脫位節段椎管最狹窄處的C/V比值及關節突關節的絞鎖情況製定手術方案,治療下頸椎陳舊性脫位能夠恢複脫位節段的椎管容積,重建下頸椎的穩定性,近期療效滿意.
목적:탐토하경추진구성탈위적수술치료방법급근기료효.방법:2004년6월～2008년2월수치하경추진구성탈위환자23례,탈화추체위C4 4례,C5 5례,C6 10례,C7 4례,균위전탈위.신경공능안ASIA분급,A급2례,B급1례,C급5례,D급8례,E급7례.입원후균행로골견인.근거술전측량적경추중시상위CT이유중건도상상탈위절단최소추관시상경여추체전후경비치(C/V비치)급관절돌관절적교쇄정황제정수술방안,15례0.5≤C/V비치<0.9적환자중,6례무관절교쇄환자직접행전로송해、복위식골융합술,9례합병관절교쇄환자선행전신마취후투시하로골견인복위술,3례복위성공후행전로식골융합술,여6례폐합복위실패(잉존재관절교쇄)적환자선행후로복위고정재행전로식골융합술;5례합병관절교쇄차0.3<C/V비치<0.5적환자선행전로송해、감압,재행후로복위고정,최후행전로식골융합술;3례합병관절교쇄차C/V비치≤0.3적환자,선전로송해,재행후로전추판절제감압、복위,최후행전로감압、식골융합술.채용경추공능잔장지수(NDI)、VAS평분급ASIA분급평개경부공능、동통부도급신경공능.결과:평균수술시간105min,술중평균출혈량280ml,술중무척수、혈관、신경손상,평균주원시간15.7d.술후병발절구지방액화1례,내고정송동1례.20례환자수방15～48개월,평균28개월,탈위절단적C/V비치유술전0.56±0.27증지술후0.86±0.07(P<0.05),술후6개월위0.88±0.06,여술후비교무현저성차이(P>0.05);술후3、6、12개월NDI、VAS평분분별교술전평균하강24%、2.4분,26%、2.8분,35%,3.3분;술후6개월소유환자식골균융합;술후12개월시10례환자적신경공능지소개선1개ASIA평분등급,여3례(A급、B급화D급각1례)무명현개선.결론:근거술전측량적경추중시상위CT이유중건도상상탈위절단추관최협착처적C/V비치급관절돌관절적교쇄정황제정수술방안,치료하경추진구성탈위능구회복탈위절단적추관용적,중건하경추적은정성,근기료효만의.
Objective:To investigate surgical strategy and short-term clinical outcome for old dislocation of the subaxial spine.Method: Twenty-three patients with old dislocation of subaxial spine were treated surgically from June 2004 to February 2008.Dislocation vertebrae were C4 in 4 patients,C5 in 5,C6 in 10 and C7 in 4.According to ASIA criterion,neurological status was grade A in 2 patients,grade B in 1,grade C in 5,grade D in 8 and grade E in 7.A11 23 patients were performed skull traction prior to surgery.The canal-vertebrae (C/V) ratio at narrowest site of involved segment was measured from CT scan images of sagittal reconstruc-tion.The surgical procedure was determined based on the ratio and the status of facets interlocking.Of 15 patients with C/V ratio over 0.5,6 with no facets interlocking underwent anterior reduction and fusion,9 with facet interlocking were managed as follows:3 cases with bilateral facets interlocking experienced closed reduction by skull traction under general anesthesia followed by anterior fusion,and the other 6 patients irresponsible to skull traction experienced posterioer realignment and fusion followed by anterior fusion and instrumentation.Five cases with C/V ratio less than 0.5 were managed with anterior release and decompression, then posterior reduction and fixation,after that anterior fusion was performed afterwise.Three cases with C/V ratio less than 0.3 underwent anterior release,followed by posterior laminectomy and reduction,finally anterior de-compression and fusion was performed.Neck disability index(NDI) and visual analog scale(VAS) was used to evaluate neck function and pain.Additionally ASIA criterion was used for neurological assessment.Result:The average surgical time was 105min,no intra-operative complications were noted.The average blood loss was 280ml,and the average hospital stay was 15.7 days.Post-operative complications were seen in 2 cases,one developed fat liquefaction at skin incision which was cured by changing dressing,the other had one screw loosing which was resolved by removal of anterior implant.20 patients were followed up for an average of 28 months (range, 15-48 months).The C/V ratio improved significantly from preoperative 0.56±0.27 to postoperative 0.86±0.07(P<0.05) and 0.88±0.06 at 6 months follow-up.NDI and VAS score at 3,6,12 months after operation decreased 24% for 2.4,26% for 2.8 and 35% for 3.3 respectively .Successful interbody fusion occurred in all 20 patients at 6 months. 10 patients had neurologic function improved,however 3 cases remained un-changed(1 grade A,l grade B and 1 grade D) at 12 months.Conclusion:The surgical strategy for old subaxial dislocation should be referred to the canal-vertebrae (C/V) ratio and status of facets interlocking at narrowest site of involved segment from CT scan images of sagittal reconstruction,which can reconstruct subaxial spine stability and ensure a good early outcome.
