Cao Peng, Liang Yu, Gong Yao-Cheng, Zheng Tao, Zhang Xin-Kai, Wu Wen-Jian
Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China.
Chin Med J (Engl). 2008 Aug 5;121(15):1364-8.
A simple, safe and effective therapeutic strategy for traumatic instability of the subaxial cervical spine, as well as its prognostic assessment, is still controversial.
The therapeutic options for 83 patients of traumatic instability of the subaxial cervical spine, whose average age was 35 years, were determined, according to the Allen-Ferguson classification, general health and concomitant traumatic conditions, neurological function, position of compression materials, concomitant traumatic disc herniation/damage, concomitant locked-facet dislocation, the involved numbers and position, and the patients' economic conditions. An anterior, posterior or combination approach was used to decompress and reconstruct the cervical spine. No operations with an anterior-posterior-anterior approach were performed.
The average follow-up was three years and nine months. Distraction-flexion and compression-flexion were the most frequent injury subtypes. There were 46, 28 and 9 cases of anterior, posterior and combination operations, respectively. The average score of the Japanese Orthopaedics Association, visual analog scale and American Spinal Cord Injury Association (ASIA) motor index improved from 11.2, 7.8 and 53.5, respectively, before operation, to 15.3, 2.6 and 67.8, respectively, at final follow-up. For incomplete spinal cord injury (SCI), the average ASIA neurological function scale was improved by 1-2 levels. Patients with complete SCI had no neurological recovery, but recovery of nerve root function occurred to different extents. After surgery, radiological parameters improved to different extents. Fusion was achieved in all patients and 12 developed complications.
The best surgical strategy should be determined by the type of subaxial cervical injury, patients' general health, local pathological anatomy and neurological function.
对于下颈椎创伤性不稳，一种简单、安全且有效的治疗策略及其预后评估仍存在争议。
根据Allen-Ferguson分类、一般健康状况和伴随的创伤情况、神经功能、压迫物位置、伴随的创伤性椎间盘突出/损伤、伴随的小关节交锁脱位、受累节段数量和位置以及患者经济状况，确定了83例平均年龄为35岁的下颈椎创伤性不稳患者的治疗方案。采用前路、后路或联合入路对颈椎进行减压和重建。未进行前后前路联合手术。
平均随访时间为3年9个月。牵张屈曲型和压缩屈曲型是最常见的损伤亚型。前路手术46例，后路手术28例，联合手术9例。日本骨科协会评分、视觉模拟量表评分和美国脊髓损伤协会（ASIA）运动指数评分分别从术前的11.2、7.8和53.5，提高到末次随访时的15.3、2.6和67.8。对于不完全性脊髓损伤（SCI），ASIA神经功能量表平均提高1 - 2个等级。完全性SCI患者神经功能无恢复，但神经根功能有不同程度恢复。术后影像学参数有不同程度改善。所有患者均实现融合，12例出现并发症。
最佳手术策略应根据下颈椎损伤类型、患者一般健康状况、局部病理解剖和神经功能来确定。
