下颈椎骨折脱位伴关节突交锁的治疗策略选择.doc

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1、下颈椎骨折脱位伴关节突交锁的治疗策略选择作者：曹鹏，梁裕，龚耀成，郑涛，张兴凯，吴文坚【摘要】［目的］探讨并评估在下颈椎骨折脱位伴关节突交锁时安全、简便和有效的治疗策略。［方法］对16例创伤性下颈椎骨折脱位伴关节突交锁的患者于清醒状态及X线透视机监视下先行早期持续闭合颅骨牵引复位。所有患者在治疗前均行X线片和MRI/CT检查及ASIA神经功能评级。持续闭合牵引复位时行动态ASTA神经功能评级及X线透视机监视。损伤至开始牵引复位的间隔平均为31h（6〜52h）。复位成功后维持颅骨牵引并择期行颈前路或颈前后路联合手术。9例患者于复位成功后再次行MRT扫描。［结果］治疗前MRT显示分别有8例和

2、5例患者存在脱位节段的椎间盘突出和损坏；ASIA神经功能评级分别为：C级7例，D级5例，E级4例。16例患者均闭合复位成功H无一例出现神经功能恶化。复位成功后再次MRI扫描显示：6例脱位节段的椎间盘突出中有2例接近自动冋纳，4例仍维持原样；3例脱位节段的椎间盘损坏中有2例维持原样，另1例传变为椎间盘突出。平均牵引重量为19kg（10〜32kg）,平均牵引时间为53min（30-135min）。［结论］当患者处于清醒及检体合作的状态下通过动态神经功能评级及X线透视机监视，对下颈椎骨折脱位伴关节突交锁行早期持续闭合颅骨牵引复位，择期根据全身及局部状况行颈前路或颈前后路联合手术是一种安全、简便

3、和有效的治疗策略。【关键词】下颈椎骨折脱位；关节突交锁；早期持续闭合牵引复位；治疗策略Therapeuticoptionstotreatesubaxialcervicalfracturedislocationwithlockedfacet/7Abstract：[Objective]Toevaluateasimple,saftyandeffectivetherapeuticoptiontotreatesubaxialcervicalfracturedislocationwithlockedfacet・[Method]Withthepatientsbeingawakeandsupervize

4、dunderXrayfluoroscopy,theauthorsusedtheearlyandcontinuedclosedskul1tractionreductiontotreate16casesoftraumaticsubaxialcervicalfracturedislocationwithlockedfacet・Beforethebeginningofthetreatment,allthepatientsweretakenforXrayplainfilmsandMRT/CTexaminationsaswellasAmericanSpinalInjuryAssociation(AS

5、IA)neurologicalfunctiongrade・ThedynamicASIAneurologicalfunctionsealeandXrayfluoroscopyexamnationswereaskedduringtheskulltraction-reductionprocedures.Theaverageintervalfromthetraumaticeventstobegintoskulltraction-reductionwas31hours(652hours)・Theauthorswouldcontinuetheskulltractiontomaintaintheana

6、tomypositionassoonastheysucceededinreducingthedislocationwithlockedfacet,forthmoretheywouldtaketheanterioroperationorcombinationswithanteriorandposterioroperationsduringthebestcondition.[Result]TheMR!seansshowedthattherewere8dischernationsand5discdisruptionsatthedislocationlevelsbeforetraction-re

7、ductionprocedures・TheASIAscalewere7gradeC,5gradeDand4gradeE,respectively.Al1the16casessucceededinreductionaswe11asnoneurologicaldeteriorationoccurred・ThepostreductionMRIscansshowedthat2discherationshadconvertedtonearly