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1、实用骨科杂志 2004年2月,第10卷,第1期 ·1·临床论著文章编号:100825572(2004)0120001204陈旧性下颈椎骨折脱位的手术治疗廖兴华,肖 刚,罗玉琛,游剑明,黄振强,饶 新(广东医学院附属湛江中心人民医院,广东湛江 524037) 摘要:目的 探讨陈旧性下颈椎骨折脱位手术治疗的意义和术式选择。方法1996年7月至2003年3月,我们对24例陈旧性下颈椎骨折脱位并脊髓损伤的病人进行了手术治疗,行前路减压复位植骨16例,其中13例应用前路钢板固定;后路侧块钉板固定5例;前后联合入路内固定3例。结果 随访时间平均18个月,所有植骨均获得愈合,不完全脊髓损伤患者功
2、能恢复按Frankel评分平均提高1.4级,所有神经根刺激症状恢复,无严重并发症的发生。结论 颈椎损伤早期治疗十分重要,陈旧性颈椎骨折脱位手术治疗仍然有效,术式的选择应根据减压、复位及稳定性重建的需要综合评估而定,包括前路、后路及前后联合三种术式。关键词:下颈椎;骨折;脱位;减压;融合;内固定中图分类号:R683.2 文献标志码:BSurgicalTreatmentofOldFracturesandDislocationsofLowerCervicalSpineLIAOXing2hua,XIAOGang,LUOYu2chen,YOUJian2ming,HUANGZhen2qiang
3、,RAOXin(Departmentoforthopaedics,TheaffiliatedZhanjiangCentralhospital,Guangdongmedicalcollege,Zhanjiang524037,China)Abstract:ObjectiveToinvestigatethevalueofsurgicaltreatmentofoldlowercervicalfracturesanddislocationsandtheselec2tionsofoperationalapproaches.MethodsFromJuly1996.tomarch2003,24cas
4、esofoldlowercervicalfracturesanddislocationsweretreatedsurgically.16caseswereoperatedwithanteriordecompression,reduction,auto2illacgraftfusion,amongwhich13caseswereappliedwithanteriorlockingplatesystems,5casesbyposteriorapprochandlateralmassscrewsandplatesystem,and3casesbycombinationofanteriora
5、ndposteriorinternalfixation.ResultsWithanaverageof18monthsfollow2up,allcasesobtainedsolidfu2sionwithoutsevereneurovascularcomplications.Patientswithincompletespinalcordinjuryhaveanimprovementofanaverageof1.4Frankellevel.Allsustainednerverootfunctionsfullyrecoveredatthetimeoffollowup.ConclusionR
6、ationaltreatmentattheearlystageforthecervicalspineinjuryisveryimportant.Surgicaltreatmentoftheoldlowercervicalfracturesanddislocationsremainstobeevaluable,andtheselectionforapproachesshouldbebasedoncomprehensiveaccessmentoftheneedofneurologicaldecompression,reductionandreconstructionalstabiliza
7、tion,includinganterior,posteriorandcombingthebothapproaches.Keywords:lowercervicalvertebrae;fracture;dislocation;decompression;fusion;internalfixation 颈椎骨折脱位常合并脊髓损伤,是最严重的颈伤6例。累及节段C3～C7,单纯压缩8例,骨折脱位部外伤之一,致死致残率高,治疗十分困难,传统的12例,椎体爆裂4例
