创伤性下颈椎骨折开放手术后的并发症及长期预后：303例连续病例系列研究
Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients.
作者信息
Fredø Hege Linnerud, Rizvi Syed Ali Mujtaba, Rezai Mehran, Rønning Pål, Lied Bjarne, Helseth Eirik
机构信息
Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Neurosurgery, Oslo University Hospital - Ullevål, N - 0407, Oslo, Norway.
出版信息
BMC Surg. 2016 Aug 15;16(1):56. doi: 10.1186/s12893-016-0172-z.
BACKGROUND
Patient selection for surgical treatment of subaxial cervical spine fractures (S-CS-fx) may be challenging and is dependent on fracture morphology, the integrity of the discoligamentous complex, neurological status, comorbidity, risks of surgery and the expected long-term outcomes. The purpose of this study is to evaluate complications and long-term outcomes in a consecutive series of 303 patients with S-CS-fx treated with open surgical fixation.
METHODS
Medical charts were retrospectively reviewed. The surviving patients participated in a prospective long-term follow-up, including clinical history, physical examination and updated cervical CT. Patients with ankylosing spondylitis were excluded from this study.
RESULTS
The median patient age was 48 years (range 14.7-93.9), and 74 % were males. Preoperatively, 43 % had spinal cord injury (SCI), and 27 % exhibited isolated radiculopathy. The median time from injury to surgery was 2 days (range 0-136). The risks of SCI deterioration and new-onset radiculopathy after surgery were 2.0 % and 1.3 %, respectively. Surgical mortality (death within 30 days after surgery) was 2.3 %. The reoperation rate was 7.3 %. At the long-term follow-up conducted a median of 2.6 years after trauma (range 0.5-9.1), 256 (99.2 %) of the patients who had survived and were living in Norway participated. Of the patients with American Injury Severity Scale (AIS) A-D at presentation, 51 % had improved one or more AIS grades. At the time of follow-up, 89 % of the patients with preoperative radiculopathy were without symptoms. Furthermore, 11 % of the patients reported severe neck stiffness, 5 % reported severe neck pain (Visual Analog Scale (VAS) ≥7), 6 % reported hoarseness, and 9 % reported dysphagia at the follow-up. The stable fusion rate, as evaluated using cervical-CT, was 98 %.
CONCLUSIONS
In this large consecutive series of patients with S-CS-fx treated with open surgical fixation, the surgical mortality was 2.3 %, the risk of neurological deterioration was 3.3 % and the reoperation rate (any cause) was 7.3 %. The neurological long-term results were good, with 51 % improvement in AIS grade and resolution of radiculopathy in 89 % of the patients. Stable fusion was excellent and was achieved in 98 % of the follow-up group.
背景
下颈椎骨折（S-CS-fx）手术治疗的患者选择可能具有挑战性，并且取决于骨折形态、椎间盘韧带复合体的完整性、神经状态、合并症、手术风险以及预期的长期预后。本研究的目的是评估303例接受开放手术固定治疗的S-CS-fx连续系列患者的并发症和长期预后。
方法
对病历进行回顾性分析。存活患者参与前瞻性长期随访，包括临床病史、体格检查和更新后的颈椎CT。强直性脊柱炎患者被排除在本研究之外。
结果
患者中位年龄为48岁（范围14.7 - 93.9岁），74%为男性。术前，43%患者存在脊髓损伤（SCI），27%表现为单纯神经根病。受伤至手术的中位时间为2天（范围0 - 136天）。术后SCI恶化和新发神经根病的风险分别为2.0%和1.3%。手术死亡率（术后30天内死亡）为2.3%。再次手术率为7.3%。在创伤后中位2.6年（范围0.5 - 9.1年）进行的长期随访中，存活且居住在挪威的256例（99.2%）患者参与。就诊时美国损伤严重程度评分（AIS）为A - D级的患者中，51%的患者AIS等级提高了一个或多个等级。随访时，术前有神经根病的患者中89%无症状。此外，11%的患者报告有严重颈部僵硬，5%报告有严重颈部疼痛（视觉模拟评分（VAS）≥7），6%报告有声音嘶哑，9%报告有吞咽困难。使用颈椎CT评估的稳定融合率为98%。
结论
在这一接受开放手术固定治疗的S-CS-fx连续大系列患者中，手术死亡率为2.3%，神经功能恶化风险为3.3%，再次手术率（任何原因）为7.3%。神经功能长期结果良好,51%的患者AIS等级提高，89%的患者神经根病症状消失。稳定融合效果极佳，随访组中98%实现了稳定融合。
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