Ye Zhe-Wei, Yang Shu-Hua, Chen Bao-Jun, Xiong Li-Ming, Xu Jian-Zhong, He Qing-Yi
Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Clin Neurol Neurosurg. 2014 Aug;123:96-101. doi: 10.1016/j.clineuro.2014.04.010. Epub 2014 May 27.
This study aimed to retrospectively examine 36 cases of bilateral cervical facet dislocations (BCFD) of the lower cervical spine who were at risk for respiratory deterioration.
The cases of 36 subjects with BCFD of the lower cervical spine who failed to achieve closed reduction were retrospectively studied. The extents of neurological injuries included posterior neck pain without neurological deficit (n=2), incomplete spinal cord injury (ISCI) (n=21), and complete spinal cord injury (CSCI) (n=13).
Among the subjects, 26 (72.22%) had dyspnea, 6 required mechanical ventilation due to respiratory muscle paralysis, 11 required tracheostomy, and 9 required intubation. All patients received posterior approach reduction, stabilization, and fusion treatment for BCFD in one operative session. For the 26 quadriparetic patients with dyspnea, priority was given to treating their respiratory problems. For the other 10 patients without dyspnea, surgical treatment for irreducible lower cervical spine dislocation was given priority. After an average follow-up period of 63 months, 21 complications were found, but all patients exhibited fusion. Twenty-one patients with ISCI exhibited improvements in their conditions of 1 or 2 grades on the American Spinal Injury Association scale, whereas those with CSCI did not improve. All 26 apnea cases improved. The majority (26) of the 36 cases with BCFD of the lower cervical spine suffered dyspnea.
Although further study is required, our study suggests that the posterior surgical approach to the cervical spine is safe and effective for patients with traumatic spondylolisthesis of the lower cervical spine concomitant with BCFD who are at risk of respiratory deterioration.
本研究旨在回顾性分析36例下颈椎双侧小关节脱位（BCFD）且有呼吸功能恶化风险的病例。
回顾性研究36例下颈椎BCFD且未能实现闭合复位的患者病例。神经损伤程度包括无神经功能缺损的颈后部疼痛（n = 2）、不完全脊髓损伤（ISCI）（n = 21）和完全脊髓损伤（CSCI）（n = 13）。
在这些患者中，26例（72.22%）出现呼吸困难，6例因呼吸肌麻痹需要机械通气，11例需要气管切开，9例需要插管。所有患者均在一次手术中接受了后路复位、固定和融合治疗BCFD。对于26例伴有呼吸困难的四肢瘫患者，优先治疗其呼吸问题。对于其他10例无呼吸困难的患者，优先进行不可复位的下颈椎脱位的手术治疗。平均随访63个月后，发现21例并发症，但所有患者均实现了融合。21例ISCI患者在美国脊髓损伤协会量表上的病情改善了1或2级，而CSCI患者没有改善。所有26例呼吸暂停病例均有改善。36例下颈椎BCFD病例中的大多数（26例）出现呼吸困难。
尽管需要进一步研究，但我们的研究表明，对于有呼吸功能恶化风险的下颈椎创伤性滑脱合并BCFD的患者，颈椎后路手术方法是安全有效的。
