单纯前路复位内固定治疗无脊髓损伤合并关节突交锁的下颈椎骨折脱位-外科学(骨科)专业论文.docx

万方数据 万方数据 目录 中文摘要·······················1 英文摘要························2 前言··························4 资料与方法·········································6 结果···············································9 讨论···············································13 结论···············································21 参考文献···········································22 致谢···············································25 文献综述···········································26 单纯前路复位内固定治疗无脊髓损伤合并 关节突交锁的下颈椎骨折脱位 中文摘要 目的：探讨单纯前路复位内固定手术治疗无脊髓损伤合并关节突交锁的下颈椎骨 折脱位的复位方法、安全性及疗效。 方法： 21 无脊髓损伤的 。观察手术时间、 术中出血量、临床疗效（按Odom标准评定），比较术前、术后即刻、术后随访的X 线上Cobb’s角、颈椎前凸（或后凸）D值的变化以及评价术后骨性融合率。 结果：21例手术均无脊髓神经损伤，无声音嘶哑、食管瘘、颈部血肿等并发症。 术后17例患者颈部疼痛及活动受限等症状完全消失，4例上肢麻木患者术后l周内 消失，2例病理反射阳性者术后1～2周内消失。术后随访时间为8个月至3年（平 均20.7个月）。神经功能Frankel分级较术前有不同程度的好转。经过统计学分析， Cobb’s角在术前（-4.6±3.87）°与术后即刻（6.8±4.09）°、术前与术后随访 （6.9±4.26）°的比较差异有统计学意义（P0.05），术后即刻与术后随访的比 较差异无统计学意义（P0.05）。D值在术前（3.2±2.8）mm与术后即刻（7.6± 3.28）mm、术前与术后随访（7.8±2.68）mm的比较差异有显著性（P0.05），术 后即刻与术后随访的比较差异无显著性（P0.05）。术后随访期间，椎体间植骨 全部融合。 结论：单纯前路复位及椎间植骨融合内固定术治疗无脊髓损伤的下颈椎骨折脱位 并关节交锁可一期达到复位，避免手术复杂，减少手术创伤和风险，并且不会造 成医源性脊髓损伤。 关键词：颈椎脱位；关节突交锁；前路手术 Anterior reduction and internal fixation for treatment of no spinal injury lower cervical fracture-dislocation combined with facet locking ABSTRACT Objective To explore the reduction technique, safety and efficacy of anterior reduction and internal fixation in treatment of lower cervical spine fracture dislocation with facet locking and no spinal cord injury. Methods 21 cases of cervical spine fracture dislocation without spinal cord injury combined facet locking were treated with anterior reduction and bone graft fusion and plate fixation. There were unilateral facet interlocking in 7 cases, and bilateral locking in 14 cases. The operation time, intraoperative blood loss, and clinical curative effect evaluated by Odom standard were observed. All patients underwent anterior decompression with fusion and plate fixation. The preoperative and postoperative Cobb’s