经颈椎前路撬拔复位内固定治疗颈椎骨折脱位(1)
摘 要：目的 探究经颈椎前路撬拔复位内固定下治疗下颈椎骨折脱位的手术方式、疗效及优势，以期为临床提供参考。方法 通过2014年2月～2017年5月32例伴有关节突绞索的患者行经颈椎前路撬拔复位内固定术，解开绞索及脊髓压迫，复位满意后行椎间植骨融合内固定术。采用ASIA分级标准评价脊髓损伤恢复程度。结果 32例患者均获得解剖复位，均无脊髓、大血管、气管、食管意外损伤等术中并发症。术后随访3～24个月，32例中ASIA A级7例转为B级1例，余治疗前后无变化，B级12例转为C级3例、转为D级1例，C级6例转为D级2例，D级4例转为E级2例。结论 经颈椎前路撬拔复位内固定下治疗颈椎骨折脱位，可一期解除关节突绞索，避免后路或前后联合入路手术等复杂操作，同时减少手术创伤及风险。
关键词：颈椎；骨折；脱位；关节突绞索；前路
中图分类号：R687.3 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.06.065
, 百拇医药
文章编号：1006-1959(2018)06-0179-04
Treatment of Cervical Vertebral Fracture and Dislocation by Anterior Cervical Pulling and Reduction and Internal Fixation
SUN Peng-hao，QIN Ru-jie，LI Yin，REN Chun-peng，WANG Peng
(Department of Spine Surgery，First People's Hospital of Lianyungang，Lianyungang 222000，Jiangsu，China)
Abstract：Objective To explore the surgical methods， therapeutic effects and advantages of cervical spine fracture and dislocation treated by anterior cervical vertebra prying and internal fixation，so as to provide reference for clinical practice.Methods From February 2014 to May 2017，32 patients with noose of articular process were treated with cervical anterior pry reduction and internal fixation，and the noose and spinal cord compression were untied.After satisfactory reduction，intervertebral fusion and internal fixation were performed.The degree of recovery of spinal cord injury was evaluated by ASIA grading standard.Results Anatomic reduction was obtained in all of the 32 cases，with no complications such as spinal cord，large vessel，trachea and esophageal injury.Follow up 3～24 months after operation，in 32 cases，7 cases of grade a ASIA were converted to B grade 1 case，but there was no change before and after treatment.12 cases of B grade were changed to 3 cases of C grade，1 case of grade D，6 cases of C grade to 2 cases of D grade，4 cases of D grade to 2 cases of E grade.Conclusion The anterior percutaneous reduction internal fixation for the treatment of cervical fracture and dislocation，a facet lifting rope，avoid the posterior or combined anterior and posterior approach such as complex operation， and reduce the surgical trauma and risk.
, 百拇医药
Key words：Cervical spine；Fracture；Dislocation；Facet noose；Anterior approach
頸椎骨折脱位(fracture-dislocation of cervical vertebra)是脊柱外科最严重的创伤之一，多合并有四肢完全或不完全性瘫痪，严重时甚至危及生命，其中关节突绞锁是其重要的病理解剖特点之一[1]，而关节突绞索也通常导致骨折脱位常规复位困难。传统手术治疗方式多经颈椎后路或前后联合入路进行，而其存在较多不足与缺陷[2，3]。如何有效达到满意复位，并减少传统手术方式的并发症是临床医师一直探究的目标。本研究收集三年来我院颈椎骨折脱位的患者资料，筛选32例合并关节突绞索、经颈椎前路撬拔复位内固定下治疗颈椎骨折脱位的资料进行回顾性分析，探究其手术方式、适应症及其所具有的优势。, 百拇医药(孙鹏浩 秦入结 李垠 任春鹏 王鹏)
关键词：颈椎；骨折；脱位；关节突绞索；前路
中图分类号：R687.3 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.06.065
, 百拇医药
文章编号：1006-1959(2018)06-0179-04
Treatment of Cervical Vertebral Fracture and Dislocation by Anterior Cervical Pulling and Reduction and Internal Fixation
SUN Peng-hao，QIN Ru-jie，LI Yin，REN Chun-peng，WANG Peng
(Department of Spine Surgery，First People's Hospital of Lianyungang，Lianyungang 222000，Jiangsu，China)
Abstract：Objective To explore the surgical methods， therapeutic effects and advantages of cervical spine fracture and dislocation treated by anterior cervical vertebra prying and internal fixation，so as to provide reference for clinical practice.Methods From February 2014 to May 2017，32 patients with noose of articular process were treated with cervical anterior pry reduction and internal fixation，and the noose and spinal cord compression were untied.After satisfactory reduction，intervertebral fusion and internal fixation were performed.The degree of recovery of spinal cord injury was evaluated by ASIA grading standard.Results Anatomic reduction was obtained in all of the 32 cases，with no complications such as spinal cord，large vessel，trachea and esophageal injury.Follow up 3～24 months after operation，in 32 cases，7 cases of grade a ASIA were converted to B grade 1 case，but there was no change before and after treatment.12 cases of B grade were changed to 3 cases of C grade，1 case of grade D，6 cases of C grade to 2 cases of D grade，4 cases of D grade to 2 cases of E grade.Conclusion The anterior percutaneous reduction internal fixation for the treatment of cervical fracture and dislocation，a facet lifting rope，avoid the posterior or combined anterior and posterior approach such as complex operation， and reduce the surgical trauma and risk.
, 百拇医药
Key words：Cervical spine；Fracture；Dislocation；Facet noose；Anterior approach
頸椎骨折脱位(fracture-dislocation of cervical vertebra)是脊柱外科最严重的创伤之一，多合并有四肢完全或不完全性瘫痪，严重时甚至危及生命，其中关节突绞锁是其重要的病理解剖特点之一[1]，而关节突绞索也通常导致骨折脱位常规复位困难。传统手术治疗方式多经颈椎后路或前后联合入路进行，而其存在较多不足与缺陷[2，3]。如何有效达到满意复位，并减少传统手术方式的并发症是临床医师一直探究的目标。本研究收集三年来我院颈椎骨折脱位的患者资料，筛选32例合并关节突绞索、经颈椎前路撬拔复位内固定下治疗颈椎骨折脱位的资料进行回顾性分析，探究其手术方式、适应症及其所具有的优势。, 百拇医药(孙鹏浩 秦入结 李垠 任春鹏 王鹏)