發(fā)布時(shí)間：2018-10-05 17:47

【摘要】：目的:探討下頸椎骨折脫位的手術(shù)方式選擇及其療效。方法:收集我院自2009年1月至2013年9月收治的單節(jié)段下頸椎骨折脫位患者126名,男性86例,女性40例,年齡16-72歲,平均46.4歲。按照ASIA分級(jí)標(biāo)準(zhǔn)進(jìn)行分級(jí):A級(jí)7例,B級(jí)48例,C級(jí)54例,D級(jí)17例。術(shù)前進(jìn)行SLIC評(píng)分,其中4分13例,5分24例,6分23例,7分29例,8分17例,9分13例,10分7例,根據(jù)患者受傷機(jī)制、形態(tài)特點(diǎn)、脊髓受壓部位及損傷程度等因素進(jìn)行分析,選擇手術(shù)方案,其中85例采用單純前路手術(shù)治療;12例行后路手術(shù);29例嚴(yán)重的骨折脫位,采用前后聯(lián)合入路。隨訪患者神經(jīng)功能改善情況,影像學(xué)評(píng)價(jià)脫位改善程度及植骨融合情況,分析三種術(shù)式SLIC評(píng)分分布特點(diǎn)。結(jié)果:126例均順利完成手術(shù),無(wú)氣管、食管損傷,無(wú)神經(jīng)損傷加重。術(shù)后佩戴頸托3個(gè)月,均獲隨訪,隨訪時(shí)間18個(gè)月,術(shù)后6個(gè)月復(fù)查,除了4例A級(jí)無(wú)恢復(fù),1例B級(jí)無(wú)恢復(fù),其余患者ASIA損傷程度分級(jí)平均提高1.2級(jí)。術(shù)后復(fù)查X線片示頸椎序列恢復(fù)良好,病例植骨均在18個(gè)月內(nèi)骨性融合(平均8.5個(gè)月),無(wú)假關(guān)節(jié)、骨不連發(fā)生,椎體間高度、生理曲度及頸椎穩(wěn)定性維持良好,前后聯(lián)合術(shù)式患者評(píng)分基本都大于8分。結(jié)論:下頸椎骨折脫位的術(shù)式選擇,需要根據(jù)受傷機(jī)制、具體損傷形態(tài)、脊髓受壓部位及損傷程度等因素進(jìn)行綜合分析,選擇合理的入路,有助于復(fù)位骨折脫位、解除神經(jīng)壓迫、促進(jìn)神經(jīng)功能的恢復(fù)、提高植骨融合率。SLIC評(píng)分反映了下頸椎骨折脫位的損傷程度,有助于選擇手術(shù)入路,SLIC評(píng)分大于等于8分時(shí)提示做前后聯(lián)合術(shù)式。合理選擇手術(shù)入路有利于減少手術(shù)并發(fā)癥。
[Abstract]:Objective: to explore the choice of surgical methods and the curative effect of fracture and dislocation of lower cervical vertebra. Methods: from January 2009 to September 2013, 126 patients (86 males and 40 females, aged 16-72 years, with an average of 46.4 years) were enrolled in our hospital. According to ASIA classification standard, 7 cases of grade A, 48 cases of grade B, 54 cases of grade C and 17 cases of grade D were classified. Preoperative SLIC score was performed in 13 cases with 4 points, 24 cases with 5 points, 23 cases with 6 points, 29 cases with 7 points, 17 cases with 8 points, 13 cases with 9 points and 7 cases with 10 points. Among them 85 cases were treated with anterior approach alone and 29 cases with severe fracture and dislocation were treated by posterior approach and combined anterior and posterior approach. The neurologic function was improved, the degree of dislocation improvement and bone graft fusion were evaluated by imaging, and the distribution characteristics of SLIC score of the three operations were analyzed. Results all 126 cases were successfully operated without trachea, esophagus injury and nerve injury. All the patients were followed up for 3 months and followed up for 18 months. 6 months after operation, except for 4 cases of grade A without recovery and 1 case of grade B without recovery, the grade of ASIA damage increased by 1.2 grade on average. The results of X-ray examination showed that the sequence of cervical vertebrae recovered well, and the bone grafts of all cases were fused within 18 months (mean 8.5 months), no pseudarthrosis, nonunion, height of vertebral body, physiological curvature and stability of cervical vertebrae were maintained well. The scores of patients with combined operation before and after operation were above 8. Conclusion: the choice of operation method for fracture and dislocation of lower cervical vertebrae should be analyzed synthetically according to injury mechanism, specific injury form, compression position of spinal cord and degree of injury, and choosing reasonable approach is helpful for reduction and dislocation of fracture and dislocation. Relieving the nerve compression, promoting the recovery of nerve function, improving the fusion rate of bone graft. SLIC score can reflect the injury degree of fracture and dislocation of the lower cervical spine, which is helpful to suggest the combined operation method when the SLIC score of the operative approach is greater than or equal to 8 minutes. Reasonable choice of operative approach is helpful to reduce the complications of operation.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3

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