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1、浙江中西医结合杂志2009年第19卷第5期ZhejiangJITCWM(Vol119No152009)2813下颈椎骨折脱位的手术方式选择与疗效分析汤呈宣刘良乐戴鸣海彭茂秀杨国敬温州医学院附属第三医院骨科瑞安325200摘要目的:探讨下颈椎骨折脱位的外科术式选择及手术治疗的临床疗效。方法:73例下颈椎骨折脱位伴颈髓损伤患者,采用前路、后路或前后联合入路进行下颈椎减压或重建,其中前路手术组40例,后路手术组26例,前后联合手术组7例。观察记录手术时间、术中出血量、平均固定节段、术中术后并发症、术后神经功能恢复和椎体
2、复位情况等。结果:平均随访时间11.2个月,植骨于术后3～4个月内均获得骨性融合,无假关节、骨不连发生;术中均无脊髓、大血管、气管、食道等损伤;前路手术在手术时间、术中出血量及平均固定节段上少于后路手术;所有患者的术前JOA评分和颈椎复位参数较术后均有改善,差异有显著性意义(P<0.05或P<0.01);结论:采用前路、后路或前后路联合入路手术治疗下颈椎不稳均可使损伤节段获得早期稳定,根据颈椎损伤机制、损伤部位及类型采取适合的手术入路是手术成功的关键。关键词颈椎骨折手术方式疗效分析SurgicalApproach
3、esforTreatmentoftheLowerCervicalVertebralFractureandDislocationTANGChengxuan,etal.TheThirdAffiliatedHospitalofWenzhouMedicalCollege,WenZhou(325200),chinaAbstractObjective:Toinvestigatesurgicalapproachesforthetreatmentofthelowercervicalvertebralfractureanddisl
4、ocation.Methods:Theclinicaldataof73patientswiththelowercervicalvertebralinjurycombinedwithspinalfromJune2003toAugest2008wereretrospectivelyanalyzed.Anteriorapproachsurgeryprocedurewasperformedin40cases,posteriorapproachin26cases,andcombinedanterior2posteriora
5、pproachin7cases.Thesurgicaltime,bloodloss,curvecorrectionrate,surgeryrelatedcomplications,neurologicalfunctionandreductionwereallrecorded.Results:Themeanfollow-uptimewas11.2months.Fusionwasachievedinallpatientsin3or4monthspostoperatively.Nopseudarthrosisorbon
6、enonunionwasobserved.Noinjuryofbloodvessels,trachea,oesophagusandspinalcordwerecausedbysurgery.Thebloodloss,surgicaltimeandcurvecorrectionrateforanteriorapproachsurgerywerelessthanthoseforposteriorcases.TheaveragescoresofJOAandreductionindexwereimprovedinallc
7、ases.Conclusion:Forthetreatmentofthelowercervicalvertebralfractureanddisloacation,anteriorapproach,posteriorapproachandcombinedanterior2posteriorapproachcanallachieveearlystability.Itisimportanttoselectasuitablesurgicalapproachaccordingtoinjurymechanisms,inju
8、rylocationanddifferenttypesofcervicalspineinstability.KeywordsCervicalvertebraeFractureSurgeryTreatment下颈椎是颈椎损伤的最常见部位,指直接或间临床资料,现报道如下。接暴力所致的第3～7颈椎(C3～C7)骨、关节或韧1临床资料带的损伤,也包含颈胸交界部即第7颈椎～第1胸本
