前路内固定术治疗下颈椎骨折脱位的临床疗效分析.docVIP

前路内固定术治疗下颈椎骨折脱位的临床疗效分析 　　【摘要】 目的：探讨前路内固定术治疗下颈椎骨折脱位的临床疗效。方法：将本院2009年7月-2012年1月确诊为下颈椎骨折脱位的39例患者作为研究对象，术前皆行颈椎CT扫描，充分评估下颈椎骨折脱位及脊髓压迫程度。术中采用后路减压复位术联合前路内固定术治疗，术后辅以康复治疗效。结果：术后随访7～21个月，39例患者脱位完全复位，损伤节段稳定，均未出现内固定断裂、松动、脱出及神经、血管、食管损伤等并发症。所有手术均顺利完成，患者均未发生围手术期并发症。JOA评分治疗评分改善率为43.17%，神经损伤均有恢复，脊髓Frankel分级平均提高1级。结论：对于下颈椎骨折脱位的患者，前路内固定术联合后路减压复位术具有有效、安全的特点，值得临床推广应用。 　　【关键词】 下颈椎骨折脱位； 前路内固定术； 后路减压复位术； JOA评分； Frankel分级 　　The Clinical Efficacy Analysis of Internal Fixation of Anterior Fusion in Treatment of Fracture and Dislocation of the Lower Cervical Spine/YANG Xiu-jin.//Medical Innovation of China，2013，10（15）：101-102 　　【Abstract】 Objective： To determine the efficacy of internal fixation of anterior fusion in treatment of fracture and dislocation of the lower cervical spine. Method： A total of 39 cases of fracture and dislocation of the lower cervical spine diagnosed in our hospital between Jul 2009 and Jan 2012 were studied， all patients received CT scan for cervical spine before operation， to evaluate the degree for dislocation of lower cervical spine and compressed spinal cord. In operation， combined therapy of internal fixation of anterior fusion and posterior decompression was applied to treat all patients. The rehabilitation was also applied to get a better prognosis. Result： The follow-up visit after operation ranged 7-21 months， all patients were with cervical reset completely，fusion bone graft，no internal fixation loose，fracture，nerve damage in different degree recovery. All operations were performed successfully， no severe complications were found during perioperative period. The improvement ratio measured with Japanese Orthopedic Association （JOA） score was 43.17 %， spinal cord Frankel grading elevated by an average of grade 1. Conclusion： For patients of fracture and dislocation of the lower cervical 下颈椎骨折脱位临床较为常见，常由于生活或劳动时暴力所致，包括下颈椎椎体骨折、脱位，也可合并不同程度脊髓损伤[1]。对于该病，治疗原则是尽快且有效骨折复位，恢复脊柱生理曲度，减轻脊髓压迫，并固定骨折部位使其重建稳定性。然而，由于部分患者遭受暴力巨大，其脊髓受到前后两个方向压迫，单纯前路或后路减压均难以取得理想疗效[2]。为此，进一步探讨前