Jiang Xingjie, Yao Yu, Yu Mingchen, Cao Yong, Yang Huilin
Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).
Department of Spinal Surgery, Affiliated Hospital to Nantong University, Nantong, Jiangsu, China (mainland).
Med Sci Monit. 2017 Feb 9;23:732-740. doi: 10.12659/msm.902961.
BACKGROUND This study aimed to treat patients with subaxial cervical facet dislocations with incomplete or without neurological deficit by a prospectively designed surgical protocol and observe the short-term clinical outcomes. MATERIAL AND METHODS Fifty-two consecutive subaxial cervical dislocation patients with incomplete or without neurological deficit were enrolled. The surgical strategy was determined based on whether or not the initial anterior closed reduction was successful and whether or not the patients were simultaneously combined with traumatic disc herniation (TDH). Postoperative radiographs were used to assess the reduction and fusion, and kyphosis and lordosis of cervical spines were calculated. The neck pain was assessed by visual analog scale. Body function and neurologic status was evaluated according to the Neck Disability Index and classification of American Spinal Injury Association. Clinical and radiologic outcomes were compared before and after the surgery and during the follow-up. The average follow-up period was 23 months. RESULTS Five patients with TDH and 17 with non-TDH were successfully treated by a single anterior approach, 22 non-TDH patients by a posterior-anterior approach, and another eight TDH patients by an anterior-posterior-anterior approach. No neurologic deterioration or other severe adverse events occurred postoperatively. The kyphosis angle of the dislocated levels was well restored after surgery, and the neck pain was significantly relieved as well. The neurologic status was obviously improved, and bony fusion was obtained in all patients within one-year follow-up. CONCLUSIONS Our prospectively designed surgical strategy is effective for the treatment of patients with subaxial cervical dislocation with incomplete or without neurological deficit.
背景 本研究旨在通过前瞻性设计的手术方案治疗下颈椎小关节脱位且伴有不完全性神经功能缺损或无神经功能缺损的患者，并观察短期临床疗效。
材料与方法 连续纳入52例下颈椎脱位且伴有不完全性神经功能缺损或无神经功能缺损的患者。根据初次前路闭合复位是否成功以及患者是否同时合并创伤性椎间盘突出症（TDH）来确定手术策略。术后通过X线片评估复位及融合情况，并计算颈椎的后凸和前凸角度。采用视觉模拟评分法评估颈部疼痛。根据颈部功能障碍指数和美国脊髓损伤协会的分类标准评估身体功能和神经功能状态。比较手术前后及随访期间的临床和影像学结果。平均随访时间为23个月。
结果 5例合并TDH的患者和17例未合并TDH的患者通过单一前路手术成功治疗，22例未合并TDH的患者采用后前路手术治疗，另外8例合并TDH的患者采用前后路联合手术治疗。术后未发生神经功能恶化或其他严重不良事件。脱位节段的后凸角度术后得到良好恢复，颈部疼痛也明显缓解。神经功能状态明显改善，所有患者在1年随访内均获得了骨性融合。
结论 我们前瞻性设计的手术策略对于治疗下颈椎脱位且伴有不完全性神经功能缺损或无神经功能缺损的患者是有效的。
