CAJ | 학술논문

目的介绍前路减压经口咽寰枢椎前路复位钢板系统(TARP)复位器辅助下治疗下颈椎骨折脱位合并关节突绞锁的方法. 方法对2010年1月至2012年10月收治的12例下颈椎骨折脱位合并关节突绞锁患者的临床资料进行回顾性研究,男9例,女3例；年龄25 ～46岁,平均30.6岁；损伤部位:C4.5 1例,C5.6 6例,C6.7 5例；根据Allen分类,所有患者均为牵拉屈曲型,其中单侧绞锁7例,双侧绞锁5例.脊髓损伤按Frankel分级:A级2例,B级2例,C级3例,D级4例,E级1例.均采用单纯前路手术复位、减压TARP复位器辅助下内固定治疗.对术前、术后神经功能、影像学改善和并发症发生情况进行分析. 结果伤口均Ⅰ期愈合,无感染发生,术后未出现神经症状加重.所有患者术后获6 ～ 36个月(平均17个月)随访.无发生内固定松动、移位或断裂.植骨均在术后6个月内获骨性融合.随访时脊髓损伤Frankel分级:A级1例,B级2例,C级2例,D级2例,E级5例. 结论在TARP复位器的辅助下,单纯前路手术能有效治疗下颈椎骨折脱位并关节突绞锁,是一种安全、简便、有效的治疗方法.
목적 개소전로감압경구인환추추전로복위강판계통(TARP)복위기보조하치료하경추골절탈위합병관절돌교쇄적방법. 방법 대2010년1월지2012년10월수치적12례하경추골절탈위합병관절돌교쇄환자적림상자료진행회고성연구,남9례,녀3례；년령25 ～46세,평균30.6세；손상부위:C4.5 1례,C5.6 6례,C6.7 5례；근거Allen분류,소유환자균위견랍굴곡형,기중단측교쇄7례,쌍측교쇄5례.척수손상안Frankel분급:A급2례,B급2례,C급3례,D급4례,E급1례.균채용단순전로수술복위、감압TARP복위기보조하내고정치료.대술전、술후신경공능、영상학개선화병발증발생정황진행분석. 결과 상구균Ⅰ기유합,무감염발생,술후미출현신경증상가중.소유환자술후획6 ～ 36개월(평균17개월)수방.무발생내고정송동、이위혹단렬.식골균재술후6개월내획골성융합.수방시척수손상Frankel분급:A급1례,B급2례,C급2례,D급2례,E급5례. 결론 재TARP복위기적보조하,단순전로수술능유효치료하경추골절탈위병관절돌교쇄,시일충안전、간편、유효적치료방법.
Objective To introduce a novel surgical treatment of lower cervical fracture dislocation complicated with facet interlocking by simple anterior decompression and a repositor for transoral atlantoaxial reduction plating (TARP).Methods We treated 12 patients with lower cervical fracture dislocation complicated with facet interlocking between January 2010 through October 2012.They were 9 men and 3women,aged from 25 to 46 years (average,30.6 years).The injury levels:C4,5 in one,C5,6 in 6 and C6,7 in 5 cases.By Allen classification,all patients belonged to the tractive flexion type,with 7 cases of unilateral interlocking and 5 cases of bilateral interlocking.According to the Frankel grading,the spinal injury was grade A in 2,grade B in 2,grade C in 3,grade D in 4 and grade E in one.All the patients were treated operatively by simple anterior reduction,decompression and internal fixation with the help of a TARP repositor.We compared the pre-and post-operative neural functions and analyzed imaging improvements and complications.Results All the 12 cases achieved reduction after operation.All incisions healed primarily without infection or worsening neural symptoms.The follow-ups ranged from 6 to 36 months,averaging 17months.No implant loosening,displacement or breakage occurred.All bone grafts got bony fusion within 6 months after operation.The follow-up Frankel grading showed grade A in one,grade B in 2,grade C in 2,grade D in 2 and grade E in 5,with improvement of one to 2 grades for all the patients.Conclusion The simple anterior decompression and a TARP repositor is a safe,simple and effective surgical treatment for lower cervical fracture dislocation complicated with facet interlocking.