CAJ | 학술논문

目的探讨Ⅰ期后、前路联合手术治疗伴关节交锁的颈椎骨折脱位的临床疗效.方法回顾性分析2011年4月-2012年12月采用Ⅰ期后、前路手术治疗的21例颈椎骨折脱位伴关节突交锁患者,其中男16例,女5例;年龄23 ～61岁,平均38.3岁.先行后路手术切除部分关节突解除关节交锁,后方侧块螺钉复位固定;然后翻身行颈前路手术,根据压迫范围采用椎体次全切除或仅行椎间盘切椎间钛网植骨融合、钛板内固定.术后通过门诊或电话随访,评估患者植骨融合及神经功能恢复情况. 结果 21例患者手术时间130～210 min,平均140 min;出血量150 ～600 ml,平均340 ml.切口均Ⅰ期愈合,无手术相关并发症.5例术后并发严重肺部感染,其中1例术后2周死于呼吸功能衰竭.生存患者随访12～30个月,平均17个月.术后3～9个月(平均6个月)钛网植骨获牢固融合,随访期间未见内固定断裂及椎间钛网移位、塌陷.按照美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级,脊髓功能末次随访较术前平均提高1级. 结论 Ⅰ期后、前路联合手术可同时实现解锁复位、椎管减压以及牢固的颈椎前后柱重建,是治疗伴关节突交锁的颈椎骨折脱位的理想方法.
목적 탐토Ⅰ기후、전로연합수술치료반관절교쇄적경추골절탈위적림상료효.방법 회고성분석2011년4월-2012년12월채용Ⅰ기후、전로수술치료적21례경추골절탈위반관절돌교쇄환자,기중남16례,녀5례;년령23 ～61세,평균38.3세.선행후로수술절제부분관절돌해제관절교쇄,후방측괴라정복위고정;연후번신행경전로수술,근거압박범위채용추체차전절제혹부행추간반절추간태망식골융합、태판내고정.술후통과문진혹전화수방,평고환자식골융합급신경공능회복정황. 결과 21례환자수술시간130～210 min,평균140 min;출혈량150 ～600 ml,평균340 ml.절구균Ⅰ기유합,무수술상관병발증.5례술후병발엄중폐부감염,기중1례술후2주사우호흡공능쇠갈.생존환자수방12～30개월,평균17개월.술후3～9개월(평균6개월)태망식골획뢰고융합,수방기간미견내고정단렬급추간태망이위、탑함.안조미국척수손상협회(American Spinal Injury Association,ASIA)분급,척수공능말차수방교술전평균제고1급. 결론 Ⅰ기후、전로연합수술가동시실현해쇄복위、추관감압이급뢰고적경추전후주중건,시치료반관절돌교쇄적경추골절탈위적이상방법.
Objective To evaluate the clinical effect of one-stage posterior-anterior approach surgery for patients with cervical fracture and dislocation combined with locked facet.Methods A retrospective review was conducted on 21 cases of cervical dislocation and fracture combined with locked facet treated by one-stage posterior-anterior approach surgery between April 2011 and December 2012.There were 16 males and 5 females at age ranging from 23 to 61 years (mean,38.3 years).Posterior unlocking reduction by partial facetectomy and lateral mass screw fixation was performed,followed by anterior decompression,internal fixation and interbody fusion by titanium meshes.Outpatient or telephone follow-up was performed to evaluate bone fusion and recovery of neurologic function.Results Mean operation time was 140 minutes (130-210 minutes) and mean blood loss was 340 ml (range,150-600 ml).All incisions got primary healing with no operation-correlated complications.Five patients complicated with severe lung infection after surgery and one died of respiratory failure two week later.Titanium meshes achieved bone fusion within 3-9 months (mean,6 months) after surgery.At a mean follow-up of 17 months (range,12-30 months),there was no implant breakage and mesh displacement or collapse.According to the American Spinal Injury Association (ASIA) score,preoperative neurologic deficit restored by mean one grade at final follow-up.Conclusion One-stage posterior-anterior approach surgery is an ideal choice for cervical fracture and dislocation combined with locked facet,for it provides unlocking reduction,canal decompression,and rigid reconstruction of the anterior-posterior column.