Jain A K, Dhammi I K, Singh A P, Mishra P
University College of Medical Sciences, University of Delhi, Dilshad Garden, Shadara, Delhi 110095, India.
J Bone Joint Surg Br. 2010 Feb;92(2):246-9. doi: 10.1302/0301-620X.92B2.22963.
The optimal method for the management of neglected traumatic bifacetal dislocation of the subaxial cervical spine has not been established. We treated four patients in whom the mean delay between injury and presentation was four months (1 to 5). There were two dislocations at the C5-6 level and one each at C4-5 and C3-4. The mean age of the patients was 48.2 years (27 to 60). Each patient presented with neck pain and restricted movement of the cervical spine. Three of the four had a myelopathy. We carried out a two-stage procedure under the same anaesthetic. First, a posterior soft-tissue release and partial facetectomy were undertaken. This allowed partial reduction of the dislocation which was then supplemented by interspinous wiring and corticocancellous graft. Next, through an anterior approach, discectomy, tricortical bone grafting and anterior cervical plating were carried out. All the patients achieved a nearly anatomical reduction and sagittal alignment. The mean follow-up was 2.6 years (1 to 4). The myelopathy settled completely in the three patients who had a pre-operative neurological deficit. There was no graft dislodgement or graft-related problems. Bony fusion occurred in all patients and a satisfactory reduction was maintained. The posteroanterior procedure for neglected traumatic bifacetal dislocation of the subaxial cervical spine is a good method of achieving sagittal alignment with less risk of iatrogenic neurological injury, a reduced operating time, decreased blood loss, and a shorter hospital stay compared with other procedures.
下颈椎陈旧性创伤性双侧关节突脱位的最佳治疗方法尚未确立。我们治疗了4例患者，受伤至就诊的平均间隔时间为4个月（1至5个月）。C5-6水平有2例脱位，C4-5和C3-4水平各有1例脱位。患者的平均年龄为48.2岁（27至60岁）。每位患者均表现为颈部疼痛和颈椎活动受限。4例中有3例存在脊髓病。我们在同一次麻醉下进行了两阶段手术。首先，进行后路软组织松解和部分关节突切除术。这使脱位部分复位，然后通过棘突间钢丝固定和松质骨移植进行补充。接下来，通过前路进行椎间盘切除术、三面皮质骨移植和颈椎前路钢板固定。所有患者均实现了近乎解剖复位和矢状面排列。平均随访2.6年（1至4年）。术前有神经功能缺损的3例患者脊髓病完全缓解。没有植骨移位或与植骨相关的问题。所有患者均发生了骨融合，并维持了满意的复位。与其他手术相比，下颈椎陈旧性创伤性双侧关节突脱位的前后路联合手术是实现矢状面排列的一种好方法，具有医源性神经损伤风险较低、手术时间缩短、失血量减少和住院时间缩短的优点。
