CAJ | 학술논문

背景：对于外伤性下颈椎骨折脱位及脊髓损伤，选择何种治疗方式目前尚存争议。 　　目的：评价植入物内固定与Halo-vest外固定联合应用治疗下颈椎骨折脱位后稳定性的临床效果。 　　方法：回顾分析汕头大学医学院第二附属医院骨科2009年1月至2011年12月收治下颈椎骨折脱位的17例患者，男13例，女4例，年龄21-65岁，平均年龄41.6岁，高处坠落伤6例，重物压砸伤3例，道路交通伤8例，伤后入院时间2 h-5 d，平均2.5 d，所有患者均在局麻下行Halo-vest外固定，然后逐步撑开，在复位情况下，行前路减压植骨、钛板螺钉内固定，通过Frankel分级与影像学检查评价治疗效果。 　　结果与结论：所有患者获得随访，随访12-24个月，平均15.4个月，常规X射线正侧位片显示骨折脱位均复位，恢复颈椎的正常序列及生理弧度，CT显示植骨融合，未发现内固定断裂及松动，按Frankel分级，显效(降低2级)5例，有效(降低1级)10例，无效2例。植入物与Halo-vest内外固定联合对下颈椎骨折脱位失稳固定的效果不仅安全可靠，并且能更好的恢复脊柱的矢状位对线。
　　배경：대우외상성하경추골절탈위급척수손상，선택하충치료방식목전상존쟁의。 　　목적：평개식입물내고정여Halo-vest외고정연합응용치료하경추골절탈위후은정성적림상효과。 　　방법：회고분석산두대학의학원제이부속의원골과2009년1월지2011년12월수치하경추골절탈위적17례환자，남13례，녀4례，년령21-65세，평균년령41.6세，고처추락상6례，중물압잡상3례，도로교통상8례，상후입원시간2 h-5 d，평균2.5 d，소유환자균재국마하행Halo-vest외고정，연후축보탱개，재복위정황하，행전로감압식골、태판라정내고정，통과Frankel분급여영상학검사평개치료효과。 　　결과여결론：소유환자획득수방，수방12-24개월，평균15.4개월，상규X사선정측위편현시골절탈위균복위，회복경추적정상서렬급생리호도，CT현시식골융합，미발현내고정단렬급송동，안Frankel분급，현효(강저2급)5례，유효(강저1급)10례，무효2례。식입물여Halo-vest내외고정연합대하경추골절탈위실은고정적효과불부안전가고，병차능경호적회복척주적시상위대선。
BACKGROUND:There is controversial in choosing the treatment method for the treatment of traumatic subaxial cervical fracture-dislocation and spinal cord injury. OBJECTIVE:To evaluate the clinical effect of implant internal fixation and Halo-vest external fixation on the stability after treatment of subaxial cervical fracture-dislocation. METHODS:A retrospective analysis was conducted on 17 patients with subaxial cervical fracture-dislocation in the Department of Orthopedics, the Second Affiliated Hospital of Shantou University Medical Col ege between January 2009 to December 2011, including 13 male patients and 4 female patients, the age was ranged from 21-65 years, average 41.6 years. There were six cases of high fal ing injury, three cases of crush injury and eight cases of traffic accident injury. The hospitalization time after injury was 2 hours to 5 days, average 2.5 days. Al the patients received Halo-vest external fixation under local anesthesia, then distraction gradual y, and received anterior decompression graft and titanium screw fixation under reduction. The treatment effect was evaluated through Frankel classification and imaging examination. RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-24 months, average 15.4 months. Normal anteraposterior X-ray film showed fracture reduction, the cervical vertebra restored to the normal sequence and physiological curvature;CT showed graft fusion without internal fixation fracture and loosing; according to Frankel classification, marked effect (decreased for 2 grade) in five cases, effective (decreased for 1 grade) in 10 cases, and ineffective in two cases. Implant internal fixation combined with Halo-vest external fixation is safe and reliable in the instability fixation of subaxial cervical fracture-dislocation, and can better restore the spinal sagittal alignment.