颈椎骨折；脱位；关节突绞锁；手术；内固定_

Ⅰ期前后路手术治疗下颈椎骨折脱位伴关节突绞锁

http://www.100md.com 《创伤外科杂志》 2006年第6期

颈椎骨折；脱位；关节突绞锁；手术；内固定,,颈椎骨折；脱位；关节突绞锁；手术；内固定,1一般资料,2手术方法,1颈椎的稳定性,2脊髓神经恢复情况,参

     摘要：目的对高能量损伤致下颈椎骨折脱位伴小关节突绞锁的患者Ⅰ期实施前后联合入路手术，探讨该方法的可行性及其疗效。方法对28例颈椎骨折脱位伴小关节突绞锁实施手术。手术分两步进行，第一步先行后路小关节突部分切除，撬拨复位，后路钉棒系统或棘突间双股“8”字钢丝内固定，髂骨植骨融合术；第二步前路椎间减压自体髂骨块移植或钛网加自体骨颗粒移植，Orion带锁钢板固定。结果术后经3~36个月随访，X线片显示28例颈椎骨折脱位均全部复位，恢复了颈椎椎体的正常序列及生理弧度，术后6个月后植骨全部融合，无钢丝、钛板、螺钉断裂及松动。28例中有10例恢复良好，14例生活自理。C级以下平均离床活动时间为2~5天，4例肌力同术前相比无明显变化。结论对严重下颈椎骨折脱位伴小关节突绞锁患者行Ⅰ期前后联合手术是可行的，具有容易复位、稳定性好、植骨易融合、便于术后护理和功能康复等优点。

    关键词：颈椎骨折；脱位；关节突绞锁；手术；内固定

    Treatment of fracturedislocation with articular process interlocking in inferior cervical vertebrae by onestage operation combined with anterior and posterior approaches

    LAN Xiufu，GUO Qingshan，LUO Xiaofeng，et al.

    (Department of Orthopaedic，Daping Hospital,Institute of Srugery Research,Third Military Medical University,Chongqing 400042,China)

    Abstract： Objective To investigate the clinical possibility and effects of the treatment of fracturedislocation with articular process interlocking in inferior cervical vertebrae caused by highenergy trauma by onestage operation with combined anterior and posterior approaches.Methods The operations consists of 2 stages.Firstly,the patients were operated through posterior approach on the small articular process by the way of partial resection,percutaneous reduction by leverage,internal fixation using posterior screwrod system or double stands ‘8’form steelwire between spinous processes,and the fusion with implantingation of iliac bone.Secondly,the operation was operated by anterior intervertebral decompression fusion with implanting autogenous iliac bone or using titanium net added autogenous bone particles,and internal fixiation by Orion locking plate system.Results After the operations,a followup was taken.Twentyeight cases had been entirely repositioned,regained the natural array and physiologic circular measure,complete fusion of the implanted bone,and no steelwire,titanium plate and screw fragmentation and loosening.Ten cases of the 28 cases had a good recovery,14 cases cauld take care of themselves,and 4 cases showed no changes as compared with preoperative symptoms.All the cases below C degree could ambulate about after 2 to 5 days.Conclusion It is possible for the patients to endure operative treatment through combined anterior and posterior approaches for severe fracturedislocation with articular process interlocking in inferior cervical vertebrae,and there are the merits of easier reposition,good stability,easier bonegrafte healing,and convenient postoperative care and functional rehabilitation. ......

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