| C7T1骨折脱位的临床特点及其Ⅰ期前后路联合手术治疗 |
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投稿时间：2013-03-11
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| 作者 | Author | 单位 | Address | E-Mail |
| 刘进 |
LIU Jin |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China |
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| 刘浩 |
LIU Hao |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China |
liuhao6304@163.com |
| 李涛 |
LI Tao |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China |
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| 龚全 |
GONG Quan |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China |
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| 曾建成 |
ZENG Jian-cheng |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China |
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| 期刊信息：《中国骨伤》2015年，第28卷，第2期，第177-181页 |
| DOI：10.3969/j.issn.1003-0034.2015.02.019 |
| 基金项目: |
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中文摘要:
目的:总结C7T1骨折脱位的临床特点,探讨其Ⅰ期前后路联合手术治疗方法.
方法:对2005年1月至2010年3月期间以Ⅰ期前后路联合手术辅以非结构性植骨治疗的8例C7T1骨折脱位患者病例资料进行回顾分析.患者均为男性,平均年龄45.0岁(32～68岁),其中6例患者入院时颈椎X线片无异常而由CT扫描明确诊断.骨折脱位按AO分型:B型4例,C型4例.合并单侧关节突交锁2例、双侧2例,术前MRI显示椎间盘损伤者6例.
结果:患者手术时间150～320 min,平均246.3 min;出血量150～600 ml,平均307.5 ml.术后出现声音嘶哑1例,术后6个月时基本恢复;无其他并发症发生.1例Frankel A级患者死亡,其余患者平均随访38.6个月(12～63个月).骨折脱位均获完全复位,术后12个月复查时骨折脱位均愈合,无假关节形成.术后脊髓功能改善明显,末次随访时A级中1例病故、1例脊髓功能无变化,B级2例恢复到C级1例、D级1例,C级1例恢复到D级,D级3例均恢复到E级.
结论: C7T1骨折脱位临床少见、容易漏诊,有必要对颈椎X线片阴性而高度怀疑损伤者进行CT检查;诊断明确后可尝试Ⅰ期前后路联合手术辅以非结构性植骨治疗. |
| 【关键词】颈椎 胸椎 骨折 脱位 骨移植 外科手术 |
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| Clinical characteristics and stageⅠoperation of anterior and posterior approaches for the treatment of cervicothoracic junction(C7T1) fracture-dislocation |
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ABSTRACT
Objective:To summary the characteristics of cervicothoracic junction(C7T1) fracture-dislocation,and explore the surgical treatment of combined anterior-posterior procedure.
Methods:From January 2005 to March 2010,8 cases of cervicothoracic junction (C7T1) fracture-dislocation were treated by stage I operation through anterior and posterior approaches,supplemented by non-structural bone graft. All patients were male with a mean age of 45.0 years old ranging from 32 to 68 years. Six cases were diagnosed clearly by CT scan but with normal cervical spine X-ray film at admission. According to AO classification,4 cases were of type B,4 cases of type C,with unilateral locked articular process in 2 cases,bilateral in 2 cases. Preoperative MRI showed intervertebral disc injury in 6 cases.
Results:The average operation time was 246.3 min ranging from 150 to 320 min. The blood loss was with an average of 307.5 ml(150 to 600 ml). One patient got hoarseness but recovered without special treatment 6 months later;No other complications happened. One patient of preoperative Frankel grade A died,the remaining patients were followed up from 12 to 63 months (38.6 months in average). These fracture-dislocations were completely reduction after operation,healed with bony union 12 months later,and no pseudoarthrosis. The function of the spinal cord improved obviously at the final follow-up,1 patient of preoperative grade A had died,and the spinal cord function of the other one had no significant changes,the 2 cases of grade B recovered to C and D respectively,1case recovered from grade C to D,and 3 case recovered from D to E.
Conclusion:Cervicothoracic junction(C7T1) fracture-dislocation is a rare clinical spine trauma,and missed easily. The CT is a necessary complement to these patients highly suspected C7T1 fracture-dislocation but with negative cervical spine X-ray film. The patients diagnosed clearly could receive stage I operation of anterior and posterior approaches,supplemented with non-structural bone graft. |
| KEY WORDS Cervical vertebrae Thoracic vertebrae Fractures Dislocations Bone transplantation Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘进,刘浩,李涛,龚全,曾建成.C7T1骨折脱位的临床特点及其Ⅰ期前后路联合手术治疗[J].中国骨伤,2015,28(2):177~181 |
| 英文格式: | LIU Jin,LIU Hao,LI Tao,GONG Quan,ZENG Jian-cheng.Clinical characteristics and stageⅠoperation of anterior and posterior approaches for the treatment of cervicothoracic junction(C7T1) fracture-dislocation[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(2):177~181 |
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