Kang Xuewen, Wang Shuanke, Wang Yuliang, Ma Yanchao
Department of Orthopedics, Second Hospital of Lanzhou University, Lanzhou Gansu 730030, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Oct;24(10):1164-7.
To discuss the selection of anterior or posterior or a combination of anterior and posterior surgical treatment of lower cervical dislocation.
A retrospectively study was performed on 28 patients with lower cervical dislocation who received operative treatment between January 2005 and October 2008. There were 19 males and 9 females with an average age of 38 years (range, 19-57 years), including 21 cases of fresh dislocation and 7 cases of old dislocation. The time from injury to hospitalization was 3 hours to 58 days. According to Allen classification, all cases had flexion injury, including 19 cases of degree I dislocation, 2 cases of degree II, 5 cases of degree III, and 2 cases of degree IV. At admission according to Frankel classification, 7 cases were rated as grade A, 4 as grade B, 9 as grade C, 3 as grade D, and 5 as grade E. All patients received open reduction, internal fixation, and iliac bone graft spinal fusion. Of them, combined anterior and posterior approach operation were given in 4 cases, single anterior operation in 22 cases, and single posterior operation in 2 cases.
All operations were completed successfully and the spinal cord injury did not deteriorate after operation. Esophageal fistula occurred in 1 case receiving anterior approach operation and was cured after 1 month. Infection of wound occurred in 1 case and was cured after dressing change. The other incisions healed by first intention. One case (Frankel grade A) died of pulmonary infection 6 weeks after operation. Twenty-seven patients were followed up 21-38 months. Two cases suffered from shoulder pain 12 months after operation. X-ray films showed complete reduction, normal height of vertebral space and normal sequence of cervical spine after operation. All cases obtained bone fusion after 3.5-6.0 months of operation (4.2 months on average). Frankel grades were improved in different degrees after operation.
The operation plan of lower cervical dislocation should be determined by the neurologic status of the patient, and the classification of the injury as a unilateral or bilateral dislocation.
探讨下颈椎脱位的前路、后路或前后联合手术治疗方式的选择。
对2005年1月至2008年10月期间接受手术治疗的28例下颈椎脱位患者进行回顾性研究。其中男性19例，女性9例，平均年龄38岁（19 - 57岁），包括新鲜脱位21例，陈旧性脱位7例。受伤至住院时间为3小时至58天。根据Allen分类，所有病例均为屈曲损伤，其中Ⅰ度脱位19例，Ⅱ度2例，Ⅲ度5例，Ⅳ度2例。入院时按Frankel分类，A级7例，B级4例，C级9例，D级3例，E级5例。所有患者均行切开复位、内固定及髂骨植骨脊柱融合术。其中，前后联合入路手术4例，单纯前路手术22例，单纯后路手术2例。
所有手术均顺利完成，术后脊髓损伤未加重。1例前路手术患者发生食管瘘，1个月后治愈。1例伤口感染，换药后治愈。其余切口一期愈合。1例（Frankel A级）术后6周死于肺部感染。27例患者随访21 - 38个月。2例术后12个月出现肩部疼痛。X线片显示术后复位良好，椎间隙高度正常，颈椎序列正常。所有病例术后3.5 - 6.0个月（平均4.2个月）获得骨融合。术后Frankel分级均有不同程度改善。
下颈椎脱位的手术方案应根据患者神经功能状态以及损伤为单侧或双侧脱位的类型来确定。
