CAJ | 학술논문

背景：下颈椎骨折脱位的治疗难点是如何改善患者的神经功能，选择手术入路应既有利于复位及脊髓的减压，又能够保证坚强固定，植骨融合。目前对下颈椎骨折脱位的术式选择仍存在较大分歧。 　　目的：探讨下颈椎骨折脱位的修复方式选择及其对植骨融合、颈椎稳定性的影响。 　　方法：收集新疆医科大学第一附属医院2009年1月至2013年9月收治的下颈椎骨折脱位患者126例，按照Frankel分级标准进行分级：A级7例，B级48例，C级54例，D级17例。术前进行下颈椎损伤分类评分，其中4分15例，5分23例，6分25例，7分22例，8分18例，9分16例，10分6例。结合患者受伤机制、形态特点、脊髓受压部位及损伤程度等因素进行分析，选择修复方案，其中前路组91例采用单纯前路手术治疗(单间隙或椎体次全切除减压、椎间植骨钛板内固定)；后路组6例行后路减压、复位、内固定；前后联合组29例采用前后联合入路。随访患者神经功能改善情况，通过影像学评价骨折愈合、植骨融合及颈椎稳定性情况。 　　结果与结论：126例患者均顺利完成手术，术中无神经损伤，无气管、食管损伤。4例术中发现硬脊髓破损，术后发生脑脊液漏，经对症处理后愈合。术后佩戴颈托3个月，均获随访，随访时间6-18个月。术后6个月复查，5例A级无恢复，1例B级无恢复，其余患者Frankel分级平均提高1.2级。术后复查X射线片示颈椎序列恢复良好，1例不融合，2例延迟愈合，其余病例植骨均在12个内骨性融合(平均8.5个月)，无假关节、骨不连发生，椎体间高度、生理曲度及颈椎稳定性维持良好。提示术前对下颈椎骨折脱位患者进行下颈椎损伤分类评分，结合损伤形态、损伤节段、脊髓受压部位等因素进行综合分析，选择合理的手术入路，可以重建脊柱的稳定性，达到良好的解剖复位，减压彻底，有利于神经功能的恢复。揹景：下頸椎骨摺脫位的治療難點是如何改善患者的神經功能，選擇手術入路應既有利于複位及脊髓的減壓，又能夠保證堅彊固定，植骨融閤。目前對下頸椎骨摺脫位的術式選擇仍存在較大分歧。 　　目的：探討下頸椎骨摺脫位的脩複方式選擇及其對植骨融閤、頸椎穩定性的影響。 　　方法：收集新疆醫科大學第一附屬醫院2009年1月至2013年9月收治的下頸椎骨摺脫位患者126例，按照Frankel分級標準進行分級：A級7例，B級48例，C級54例，D級17例。術前進行下頸椎損傷分類評分，其中4分15例，5分23例，6分25例，7分22例，8分18例，9分16例，10分6例。結閤患者受傷機製、形態特點、脊髓受壓部位及損傷程度等因素進行分析，選擇脩複方案，其中前路組91例採用單純前路手術治療(單間隙或椎體次全切除減壓、椎間植骨鈦闆內固定)；後路組6例行後路減壓、複位、內固定；前後聯閤組29例採用前後聯閤入路。隨訪患者神經功能改善情況，通過影像學評價骨摺愈閤、植骨融閤及頸椎穩定性情況。 　　結果與結論：126例患者均順利完成手術，術中無神經損傷，無氣管、食管損傷。4例術中髮現硬脊髓破損，術後髮生腦脊液漏，經對癥處理後愈閤。術後珮戴頸託3箇月，均穫隨訪，隨訪時間6-18箇月。術後6箇月複查，5例A級無恢複，1例B級無恢複，其餘患者Frankel分級平均提高1.2級。術後複查X射線片示頸椎序列恢複良好，1例不融閤，2例延遲愈閤，其餘病例植骨均在12箇內骨性融閤(平均8.5箇月)，無假關節、骨不連髮生，椎體間高度、生理麯度及頸椎穩定性維持良好。提示術前對下頸椎骨摺脫位患者進行下頸椎損傷分類評分，結閤損傷形態、損傷節段、脊髓受壓部位等因素進行綜閤分析，選擇閤理的手術入路，可以重建脊柱的穩定性，達到良好的解剖複位，減壓徹底，有利于神經功能的恢複。
배경：하경추골절탈위적치료난점시여하개선환자적신경공능，선택수술입로응기유리우복위급척수적감압，우능구보증견강고정，식골융합。목전대하경추골절탈위적술식선택잉존재교대분기。 　　목적：탐토하경추골절탈위적수복방식선택급기대식골융합、경추은정성적영향。 　　방법：수집신강의과대학제일부속의원2009년1월지2013년9월수치적하경추골절탈위환자126례，안조Frankel분급표준진행분급：A급7례，B급48례，C급54례，D급17례。술전진행하경추손상분류평분，기중4분15례，5분23례，6분25례，7분22례，8분18례，9분16례，10분6례。결합환자수상궤제、형태특점、척수수압부위급손상정도등인소진행분석，선택수복방안，기중전로조91례채용단순전로수술치료(단간극혹추체차전절제감압、추간식골태판내고정)；후로조6례행후로감압、복위、내고정；전후연합조29례채용전후연합입로。수방환자신경공능개선정황，통과영상학평개골절유합、식골융합급경추은정성정황。 　　결과여결론：126례환자균순리완성수술，술중무신경손상，무기관、식관손상。4례술중발현경척수파손，술후발생뇌척액루，경대증처리후유합。술후패대경탁3개월，균획수방，수방시간6-18개월。술후6개월복사，5례A급무회복，1례B급무회복，기여환자Frankel분급평균제고1.2급。술후복사X사선편시경추서렬회복량호，1례불융합，2례연지유합，기여병례식골균재12개내골성융합(평균8.5개월)，무가관절、골불련발생，추체간고도、생리곡도급경추은정성유지량호。제시술전대하경추골절탈위환자진행하경추손상분류평분，결합손상형태、손상절단、척수수압부위등인소진행종합분석，선택합리적수술입로，가이중건척주적은정성，체도량호적해부복위，감압철저，유리우신경공능적회복。
BACKGROUND:The treatment of lower cervical spine fracture and dislocation is aimed to improve neurological functions of patients, the selection of surgical approach is conductive to the reduction and spinal decompression, also maintain strong fixation and bone graft fusion. OBJECTIVE:To explore the restoration approach of lower cervical spine fracture and dislocation, and investigate the effect on bone graft fusion and cervical stability. METHODS: A total of 126 patients with lower cervical spine fracture and dislocation were treated surgicaly from January 2009 to September 2013 in the First Affiliated Hospital of Xinjiang Medical University. Based on Frankel system, 7 cases were grade A, 48 were grade B, 54 were grade C, and 17 were grade D before surgery. Based on SLIC system, 15 cases were 4 points, 23 were 5 points, 25 were 6 points, 22 were 7 points, 18 were 8 points, 16 were 9 points, and 6 were 10 points. Surgical approaches were determined based on the SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree. Anterior surgery (single gap or cervical corpectomy and fusion, bone graft internal fixation) was performed on 91 cases; Posterior treatment (posterior decompression, reduction and internal fixation) was performed on 6 cases; Combined posterior and anterior approach was performed in 29 cases. The neurological function improvement was evaluated at folow-ups; fracture healing, bone graft fusion and cervical stability were determined with imaging findings. RESULTS AND CONCLUSION:Al the 126 patients underwent surgery safely without severe complications such as tracheal or esophageal injury. Four patients appeared spinal cord injury and cerebrospinal fluid leakage, which were healed after corresponsive intervention. Al patients were immobilized in a hard colar for 3 months postoperatively and were folowed up for 6-18 moths. At postoperative 6 months, 5 cases of grade A were not recovered, one case of grade B was not recovered, 1-2 degree of neurological function recovery was achieved in the remaining cases by Frankel system. X-ray finding showed the good recovery of cervical vertebrae sequence after operation. Fusion was achieved in al cases within 12 months (mean 8.5 months) except non-fusion in one case and delayed fusion in two cases. There was no pseudarthrosis or nonunion occurred. The interbody height, physiological curvature and cervical stability maintained wel. The SLIC system, with a combination of sub-axial injury classification system, the type of fracture, spinal cord compression, and cervical spine injury degree should be considered before surgery. Reasonable selection of surgical approach can reconstruct spinal stability and achieve anatomical reduction and complete decompression, which is conducive to the recovery of neurological function.