全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁

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1、全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁陈举1张朝春2【摘要】目的：探讨全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁的机理和临床效果。方法：对60例下颈椎骨折脱位伴关节突交锁患者临床资料进行回顾性分析。其中单侧小关节突交锁23例，双侧小关节突交锁37例。56例合并脊髓损伤，神经功能按美国脊髓损伤学会的分类标准（ASIA）：A型5例，B型21例，C型23例，D型7例。所有患者入院生命体征平稳后立即在全麻下行颅骨牵引，复位后行前路减压Cage融合钛板内固定术或损伤节段椎体次全切钛网植入植骨钛板内固定术。结果：所有患者完全复位，无大血管、食

2、道意外损伤；5例术后出现轻度吞咽困难、声音嘶哑，予激素、雾化治疗后逐渐恢复；2例ASIAA级患者于术后15天、19天死于肺部感染、呼吸衰竭。余58例患者均获得18-30个月随访，平均24个月。按ASIA分型，3例A型治疗前后无变化；B型21例，转为C型13例、D型5例；C型23例，转为D型13例，E型8例；D型7例，均转为E型。结论：全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁是相对安全有效的治疗方法。1第一作者简介：陈举在读硕士福建中医药大学骨伤学院350108电话：18120829531邮箱：291827411@qq.com2通讯作者：张朝春福建中医药大学

3、骨伤学院350108电话：13705001329邮箱：zxkzxl@163.com【关键词】全麻；颅骨牵引；颈前路手术；下颈椎骨折脱位；关节突交锁Skulltractionundergeneralanesthesiawithanteriorcervicaldecompressionandfusionforcervicalfracturedislocationwithshutdown【AbstractObjective】Toinvestigatetheskulltractionundergeneralanesthesiaandtreatmentofanteriorcervicalde

4、compressionandfusionfracturedislocationwithlockedfacetofthemechanismandclinicaleffect.Methods:60casesoflowercervicalspinefractureanddislocationwithlockedfacetclinicaldatawereretrospectivelyanalyzed.Whichunilateralfacetinterlocking23cases,bilateralfacetinterlocking37cases.56casesofspinalcordinj

5、ury,nervefunctionaccordingtoAmericanSpinalInjuryAssociationclassificationcriteria(ASIA):Atype5cases,B-21cases,C-23cases,D-sevencases.Allpatientsadmittedtohospitalwithstablevitalsignsimmediatelyafteranesthesiaskulltraction,resetunderwentanteriordecompressionandfusionfixationCageordamagedvertebr

6、alsegmenttimesthefull-cuttitaniumandtitaniummeshimplantedinthebonetitaniumplatefixation.Results:Allpatientscompletelyreset,nolargebloodvessels,esophagusaccidentalinjury;5patientshadmilddifficultyswallowing,hoarseness,tohormones,graduallyrecoveredafterspraytreatment;2casesASIAAlevel15daysafters

7、urgerypatients,19daysdiedoflunginfection,respiratoryfailure.Morethan58casesofpatientswerefollowedupfor18-30months,withanaverage24months.ByASIAclassification,threecasesoftypeAdidnotchangebeforeandaftertreatment;B-type21cases,13casesintoC