| 一期前后联合手术减压固定治疗严重下颈椎疾病 |
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Received:May 18, 2006
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| 作者 | Author | 单位 | Unit | E-Mail |
| 马维虎 |
MA Wei-hu |
宁波市第六医院骨科,浙江宁波315040 |
Department of Orthopaedics,the Sixth Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
maweihu@cnoo.lne |
| 徐荣明 |
XU Rong-ming |
宁波市第六医院骨科,浙江宁波315040 |
Department of Orthopaedics,the Sixth Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 孙韶华 |
SUN Shao-hua |
宁波市第六医院骨科,浙江宁波315040 |
Department of Orthopaedics,the Sixth Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 黄雷 |
HUANG Lei |
宁波市第六医院骨科,浙江宁波315040 |
Department of Orthopaedics,the Sixth Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 应江炜 |
YING Jiang-wei |
宁波市第六医院骨科,浙江宁波315040 |
Department of Orthopaedics,the Sixth Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 蒋伟宇 |
JIANG Wei-yu |
宁波市第六医院骨科,浙江宁波315040 |
Department of Orthopaedics,the Sixth Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 张思胜 |
ZHANG Si-sheng |
宁波市第六医院骨科,浙江宁波315040 |
Department of Orthopaedics,the Sixth Hospital of Ningbo,Ningbo 315040,Zhejiang,China |
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| 期刊信息：《中国骨伤》2007年20卷，第3期，第148-151页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目:宁波市科委立项课题(编号:20043004) |
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目的:对严重下颈椎疾病,包括骨折脱位、脊髓型颈椎病及颈椎后纵韧带骨化症采取一期前后联合手术治疗,探讨该疗法的可行性和疗效。
方法:本组48例中男35例,女13例;年龄21~75岁,平均48岁。严重下颈椎骨折脱位16例,伤后至手术时间5 d~3周;钳夹脊髓型颈椎病(脊髓夹持型颈椎病)19例;严重颈椎后纵韧带骨化症13例。本组均采用全麻下一期前后路联合减压,前路带锁钢板固定,自体植骨或钛网加自体骨移植。本组前路采用Orion带锁钢板17例,AO带锁钢板3例,Zephir带锁钢板28例;前路减压后采用自体骨移植9例,采用钛网加自体骨移植39例。后路采用Axis钛板螺钉固定45例,Vertex系统3例,其中采用侧块螺钉9例,颈椎椎弓根螺钉39例。
结果:随访6~36个月,经椎弓根螺钉固定者术后经斜位及CT检查发现有7个椎弓根螺钉位置稍差,其中6枚穿破外侧皮质,1枚穿破内侧皮质,但无神经血管并发症。假关节形成1例,而且1枚螺钉断裂。钳夹型颈椎病19例和后纵韧带骨化症13例,术后疗效按JOA评分标准评定,术后1周及1、3、6个月评分均较术前增加(P<0.05)。
结论:严重下颈椎疾病采用一期前后联合手术治疗是可行的,术后稳定性好,患者康复快。 |
| [关键词]:颈椎病 颈椎 骨折 脱位 骨折固定,内 |
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| One-stage operation through combined anterior and posterior approach for the treatment of severe lower cervical spine disease |
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Abstract:
Objective: To study feasibility and therapeutic effects of one-stage operation through combined anterior and posterior approach for the treatment of severe lower cervical spine diseases including severe fracture,cervical spondylotic myelopathy(CSM) and ossification of cervical posterior longitudinal ligament(OPLL).
Methods: Among 48 patients,35 patients were male and 13 patients were female,ranging in age from 21 to 75 years,with an average of 48 years.Sixteen patients had severe lower cervical fracture and dislocation,and the interval from trauma to operation ranged from 5 days to 3 weeks.Nineteen patients had pinching CSM and other 13 patients had OPLL.After one-stage decompression through combined anterior and posterior approach under general anaesthesia,internal fixation and bone-grafting were performed from anterior approach,including Orion locked steel plaste fixation in 17 patients,AO plates in 3 patients,Zephir locked plates in 28 patients,autogenous-iliac strut grafts in 9 patients,and Titanium mesh cage combined with autogenous-iliac strut-grafting in 39 patients.In the meantime,internal fixation from posterior approach were also performed,including Axis Titanium screws in 45 patients,Vertex in 3 patients,among which 9 patients were treated with lateral mass screw and 39 patients with pedicle screws.
Results: All the patients were followed(ranged,6 to 36 months).There were few postoperative complications,and preoperative disorder segments were stable after combined anterior and posterior internal fixation.Six screws penetrated the outer cortex of the vertebra without clinical consequences.One screw spinal canal,but also without nerve and blood vessel complications.There was 1 screw breakage.According to JOA assessment system,the score of patients with CSM and OPLL increased at 1st week,1st,3rd,and 6th months after operation as compared with those of preoperation(P<0.05).
Conclusion: The immediate and long-term stability of the disorder segments may be obtained by the combined anterior and posterior internal fixation in the patients with severe lower cervical disease.This technique is benefit to the patients for the functional recover of the spinal cord and early rehabilitation. |
| KEYWORDS:Cervical spondylopathy Cervical vertebrae Fractures Dislocation Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 马维虎,徐荣明,孙韶华,黄雷,应江炜,蒋伟宇,张思胜.一期前后联合手术减压固定治疗严重下颈椎疾病[J].中国骨伤,2007,20(3):148~151 |
| 英文格式: | MA Wei-hu,XU Rong-ming,SUN Shao-hua,HUANG Lei,YING Jiang-wei,JIANG Wei-yu,ZHANG Si-sheng.One-stage operation through combined anterior and posterior approach for the treatment of severe lower cervical spine disease[J].zhongguo gu shang / China J Orthop Trauma ,2007,20(3):148~151 |
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