Lifeso R M, Colucci M A
Spine Center at Erie County Medical Center, Buffalo, NY 14215, USA.
Spine (Phila Pa 1976). 2000 Aug 15;25(16):2028-34. doi: 10.1097/00007632-200008150-00005.
A retrospective analysis of 32 rotationally unstable cervical fractures treated by brace, halo vest, or posterior surgical constructs plus fusion is compared with a second, prospective study of 18 similar fractures treated by early anterior discectomy, fusion, and plating.
To characterize an often unrecognized fracture pattern and compare various methods of management to identify the most effective treatment.
The rotationally unstable cervical spine fracture (compression-extension Stage 1) involves a hyperextension and lateral flexion injury, resulting in a unilateral pedicle, facet complex, and/or lamina fracture under compression and anterior annular disruption under tension. This fracture pattern allows a rotatory spondylolisthesis of the spine around the axis of the intact lateral mass and facet complex.
A retrospective review was made of 284 cervical fractures, identifying 32 compression-extension Stage 1 fractures that were treated by a variety of techniques. The results of that study led to a second (prospective) study, in which 18 similar fractures were treated by early anterior discectomy, fusion, and plating.
Nonoperative treatment was uniformly unsuccessful. Posterior stabilization and fusion procedures led to unsuccessful results in 45%, related either to late kyphosis because of disc collapse or the inability of midline stabilization procedures to control rotational instability. Anterior fusion resulted in solid union without residual deformity in all cases. All four patients in the prospective study with incomplete cord lesions showed improvement in cord function, as did seven patients who had radiculopathy.
Although posterior bony injury is the usual radiographic finding, the anterior disc and anterior longitudinal ligament disruption are the more significant injuries and lead to late collapse and kyphotic deformity. Early anterior fusion is recommended in compression- extension Stage 1 cervical spine injuries.
对32例采用支具、头环背心或后路手术固定加融合治疗的旋转不稳定型颈椎骨折进行回顾性分析，并与另一项前瞻性研究进行比较，该前瞻性研究对18例采用早期前路椎间盘切除术、融合术和钢板固定术治疗的类似骨折进行了研究。
描述一种常未被识别的骨折类型，并比较各种治疗方法以确定最有效的治疗方案。
旋转不稳定型颈椎骨折（压缩-伸展1期）涉及过伸和侧屈损伤，导致单侧椎弓根、关节突复合体和/或椎板在压缩下骨折，以及前纵韧带在张力下断裂。这种骨折类型允许脊柱围绕完整侧块和关节突复合体的轴发生旋转性椎体滑脱。
对284例颈椎骨折进行回顾性研究，识别出32例采用多种技术治疗的压缩-伸展1期骨折。该研究结果促成了第二项（前瞻性）研究，其中18例类似骨折采用早期前路椎间盘切除术、融合术和钢板固定术治疗。
非手术治疗均未成功。后路稳定和融合手术导致45%的结果不理想，这要么是由于椎间盘塌陷导致后期后凸畸形，要么是由于中线稳定手术无法控制旋转不稳定。前路融合在所有病例中均实现了牢固融合且无残留畸形。前瞻性研究中所有4例伴有不完全脊髓损伤的患者脊髓功能均有改善，7例患有神经根病的患者也是如此。
尽管通常的影像学表现是后路骨质损伤，但前路椎间盘和前纵韧带损伤更为严重，会导致后期塌陷和后凸畸形。对于压缩-伸展1期颈椎损伤，建议早期进行前路融合。
