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find Keyword "下颈椎骨折" 3 results
  • 椎体沉头螺钉在下颈椎骨折伴脱位中的临床初步应用

    目的 总结颈椎椎体沉头螺钉在下颈椎骨折伴脱位内固定治疗中的临床应用价值。 方法 2007 年1 月- 2010 年5 月,收治16 例下颈椎骨折伴脱位患者。男12 例,女4 例;年龄21 ~ 52 岁,平均36.8 岁。累及间隙分别为C4、5 6 例,C5、6 8 例,C6、7 2 例。脊髓损伤程度按 Frankel 功能分级:B 级4 例,C 级6 例,D 级6 例。受伤至手术时间8 ~ 20 h,平均10.8 h。先行后路复位固定,再行前路减压椎间植骨融合,应用椎体沉头螺钉将自体髂骨块固定于上、下椎体。 结 果 患者无手术相关并发症发生。术后3 d X 线片示均获得完全复位,颈椎恢复正常序列及椎体高度。椎体沉头螺钉与椎体前缘夹角为平均28.3°,与椎体后缘距离为平均2.34 mm。16 例均获随访,随访时间6 ~ 24 个月,平均13.8个月。颈椎椎间高度、生理曲度和稳定性维持良好。植骨均于术后3 ~ 5 个月获骨性融合。脊髓损伤程度根据Frankel分级标准评定均有不同程度恢复,D ~ E 级所占比例为81.3%(13/16),显著高于治疗前的37.5%(6/16)(χ2=6.348,P=0.012)。 结论 在联合颈椎后路内固定的情况下,使用颈椎椎体沉头螺钉可有效重建下颈椎稳定性,手术操作简便。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 下颈椎骨折合并齿状突骨折的手术治疗

    目的 总结手术治疗下颈椎骨折合并齿状突骨折的临床疗效和方法。 方法 2001 年3 月- 2008年6 月,在颅骨牵引基础上,采用颈前路减压病椎次全切除、自体髂骨植入、前路钛板内固定、齿状突骨折闭合复位空心加压螺钉内固定,治疗6 例下颈椎骨折合并齿状突骨折男性患者。年龄20 ~ 52 岁,平均34 岁。受伤至就诊时间6 h ~ 5 d。损伤节段:C4 1 例,C5 3 例,C6 2 例。下颈椎骨折根据ALLEN 分类,屈曲压缩型4 级2 例,纵向压缩型3 级4 例。齿状突骨折Anderson Ⅱ型2 例,浅Ⅲ型4 例。入院时脊髓损伤采用Frankel 分级:A 级2 例,B 级2 例,C 级2 例。 结果 术后患者切口均Ⅰ期愈合。6 例均获随访,随访时间6 ~ 72 个月,平均44 个月。齿状突骨折3 ~ 6 个月愈合,平均4.3 个月。1 例Frankel A 级患者术后6 个月死于肺感染,1 例Frankel A 级患者术后神经症状无改善,余4 例均有不同程度恢复。 结论 下颈椎骨折合并齿状突骨折临床少见,采用同一切口手术治疗不增加创伤,利于神经功能恢复,便于护理。

    Release date:2016-08-31 05:48 Export PDF Favorites Scan
  • Treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of interlocking facet through the Luschka joint and anterior lamina space

    ObjectiveTo investigate the effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space.MethodsTwelve patients with lower cervical interlocking fracture and dislocation were analyzed retrospectively between January 2013 and June 2015. There were 7 males and 5 females, aged 25-59 years with an average age of 38.4 years. The disease duration was 9.6 hours to 100 days with an average of 7.3 days. There were 8 cases of unilateral locking and 4 cases of bilateral locking; 4 cases of old injury and 8 cases of fresh injury. The injured segments were 2 cases of C3, 4, 5 cases of C4, 5, 3 cases of C5, 6, and 2 cases of C6, 7. According to Meyerding classification, there were 9 cases of grade Ⅰ and 3 cases of grade Ⅱ. According to the functional classification of American Spinal Injury Association (ASIA), there were 2 cases of grade C, 6 cases of grade D, and 4 cases of grade E. The interlocking facet was released through the Luschka joint and anterior lamina space, and the anterior cervical fusion and internal fixation were used to treat the fracture and dislocation of the lower cervical spine. The recovery of spinal cord function was judged by the functional classification of ASIA; visual analogue scale (VAS) score, neck disability index (NDI) score, modified Japanese Orthopaedic Association (m-JOA) score were used to evaluate the clinical efficacy; the Cobb angle of fusion segment were observed by X-ray film. The intervertebral bone graft fusion was evaluated at 6 months after operation.ResultsThe average operation time was 78.30 minutes, the average intraoperative blood loss was 167.30 mL, and the average postoperative drainage volume was 58.12 mL. No blood transfusion was given during or after operation. During the operation, there was no accidental injury of large blood vessels, esophagus, and trachea; no laryngo edema, dysphagia, hoarseness, and cerebrospinal fluid leakage occurred after operation; no spinal cord injury or nerve root injury aggravated; the incision healed by first intention, and no infection occurred. All 12 cases were followed up 15-20 months, with an average of 16.5 months. The symptoms and function of the nerve injury were significantly improved when compared with that before operation. Re-examination of the cervical spine X-ray film at 6 months after operation showed that the Cage or bone graft was not displaced or broken, the screw was not loosened or detached, and the intervertebral graft fusion rate was up to 100%. At last follow-up, the ASIA grade, Cobb angle of fusion segment, neck pain VAS score, m-JOA score, and NDI score were significantly improved when compared with preoperative one (P<0.05).ConclusionThe effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space is clear, which not only can make the injured segment get satisfactory reduction, immediate stability and reconstruction, and full decompression, but also can effectively prevent the secondary injury of spinal cord.

    Release date:2021-01-29 03:56 Export PDF Favorites Scan
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