ObjectiveTo investigate the effect of one-stage posterior reduction single nail and rod fixation combined with the anterior operation on lower cervical fracture-dislocation combined with unilateral locked facet.MethodsA retrospective analysis of 28 patients with lower cervical fracture-dislocation combined with unilateral locked facet who underwent one-stage posterior-anterior approach surgery between June 2012 and March 2017 were conducted. The Cobb angle, vertebral body horizontal displacement, height of intervertebral space, recovery of nerve function and operative complications were observed before and after operation.ResultsAll patients were followed up for 12-24 months, with an average of (18.9±4.7) months. All the patients received good reposition after operation without complications such as large blood vessels, trachea, esophagus, spinal dura mater injury and so on. The incisions healed well in all patients. Postoperative complications: postoperative hoarseness and dysphagia occured in 3 cases, pharynx and larynx pain in 8 cases, pulmonary infection in 1 case, and hyponatremia in 2 cases; all patients recovered after the related symptomatic treatment. Postoperative X-ray showed that all the patients were completely corrected without residual small joint semi dislocation and kyphosis. No spinal cord or nerve injury aggravators occurred after surgery. The neurological function of all patients was improved to different degrees 12 months after operation. American Spinal Cord Injury Association (ASIA) classification showed that, of the 6 cases classified as type B preoperatively, 4 cases turned into type C and 2 cases into type D postoperatively; of the 13 cases classified as type C preoperatively, 10 cases turned into type D and 3 into type E postoperatively; and all the 8 cases classified as type D preoperatively turned into type E postoperatively. The ASIA scores increased by 1-2 levels compared with those before operation (P<0.05). The height of cervical intervertebral space, physiological curvature and cervical stability of all patients were well maintained 7 days and 12 months after operation, which were significantly improved compared with those before operation (P<0.05). There was no significant difference between the two follow-up visits at 7 days and 12 months after operation. The Japanese Orthopaedic Association score at 12 months after operation (14.6±2.3) was significantly better than that before operation (6.8±2.6), and the average improvement rate was (79.6±18.8)% (P<0.05). No complications such as screw loosening, fracture or displacement occurred during follow-up.ConclusionOne-stage posterior reduction single nail and rod fixation combined with the anterior operation is safe and effective for the treatment of lower cervical fracture-dislocation combined with unilateral locked facet.

Citation： LI Wen, YANG Han, WANG Song, WANG Qing, KANG Jianping. One-stage posterior reduction single nail and rod fixation combined with the anterior operation for lower cervical fracture-dislocation combined with unilateral locked facet. West China Medical Journal, 2018, 33(9): 1085-1089. doi: 10.7507/1002-0179.201808042 Copy