90-下颈椎双侧关节突脱位复位方式探讨三院王如林.docVIP

下颈关节突脱位复位方式探讨 王如林，欧阳甲，蒋国强, 陆建猛，韩成钢 （宁波大学医学院附属医院脊柱外科，浙江宁波 315020） 摘要： [目的] 探讨下颈椎关节突脱位的复位方式及治疗效果。[方法] 2003年~2008年3月收治下颈椎关节突脱位患者22例，其中18例行MRI检查，9例有椎间盘突出，占50%。依据复位前是否切除损伤的椎间盘分为2组，分析复位后神经损伤的变化。[结果] 未切除损伤的颈椎间盘，复位中1例、复位后3例神经症状加重。（ASIS）分级，C—A1例，C—B1例，C—D2例。切除组复位后神经症状无1例加重。[结论] 下颈椎关节突脱位大多数并发椎间盘突出，未切除椎间盘复位可能加重神经损伤。前路损伤椎间盘切除、复位、椎间植骨可一次完成，不但能避免各种继发性损伤，而且可即刻稳定，便于护理，融合率高。 关键词：颈椎 关节突 脱位 复位 Evaluation of reductive method of lower cervical facet dislocations // WANG Ru-lin, OU Yang-jia, JIANG Guo-qiang, et al. Department of Spine Surgery,The Hospital of ningbo University,zhejiang ningbo 315020 Abstract：[ objective] To discuss the reductive metod and clinical result of lower cervical bilateral facet dislocation. [Method] 22 cases with lower cervical facet dislocation treated from 2003 to 2008 .According to resect the injuried disc annulus pre-reduction or not ,the patients were divided tow groups .The variation of neurological fauction level were classified according to ASIA grade system .Among 18cases examined by MRI ,associated with disc herniated in 9 cases（50%） .[Result] The average time of follow-up was 18 months. Neurological symptom became more severe in 1 cases which injuried disc annulus weren’t resected in-reduction and in 3 cases which injuried disc weren’t resected post-reduction .ASIA grade deteriorated: 1 case upgrade from C to A.1 case upgrade from C to B.2 case upgrade C to D.The But no one occurred in another group. [Conclusion] A lot of lower cervical facet dislocation have associated disc herniations.If injuried disc isn’t resected,the neurological symptom may become more severe .Resection injuried disc ,reduction .Bone grafting .Can be settled in one time ,in order to avoid secondarg spine cord injury. Key words Cervical spine; facet; Dislocation; Reduction 下颈椎关节突脱位多合并椎间盘损伤，且极不稳定，治疗不当易加重神经损伤，治疗方式选择闭合复位还是手术复位，手术方法是前路还是后路，目前还存在着争论。2003年~2008年3月，我们共救治22例下颈椎关节突脱位，分析报告如下。 临床资料： 1.1一般资料本组 本组22 例中男19例，女3例。年龄17~63