Ding Chen, Wu Ting-Kui, Gong Quan, Li Tao, Ma Li-Tai, Wang Bei-Yu, Deng Yu-Xiao, Liu Hao
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2017 Nov;96(46):e8809. doi: 10.1097/MD.0000000000008809.
Lower cervical dislocations are often missed at the time of initial injury for several reasons. The treatment of old facet dislocations of the lower cervical spine is difficult, and the optimal method has not been established. The objective of the present study was to evaluate the clinical outcomes of a surgical technique, anterior release, and nonstructural bone grafting combined with posterior fixation, for the treatment of old lower cervical dislocations with locked facets.This was a retrospective study of 17 patients (13 men and 4 women) with old facet dislocations, who underwent the same surgical treatment at our hospital between April 2010 and January 2016. The anterior procedure was conducted to remove the fusion mass and to achieve discectomy and morselized bone grafting. Subsequent posterior procedure included release, reduction, and posterior fusion. The neurologic status, clinical data (Japanese Orthopedic Association [JOA], Neck Disability Index [NDI], and Visual Analog Scale [VAS] scores), and radiographic information (local sagittal alignment and bone graft fusion) were recorded and evaluated pre and postoperatively.All patients achieved a nearly complete reduction intraoperatively. The mean operative time was 178 ± 49 minutes. The mean blood loss was 174 ± 73 mL. Each patient completed at least 12 months of follow-up. The mean follow-up duration was 32.6 ± 18.5 months. The neurologic status according to the Frankel grade was significantly improved at the last follow-up. The JOA, NDI, and VAS scores all demonstrated significant improvements compared with the preoperative values (P < .05). The kyphosis angle of the dislocated segments was 10.5 ± 5.9° at preoperation, and was corrected to 5.9 ± 4.3° lordosis postoperatively. Anterior and posterior solid fusion was observed in all patients within 12 months of follow-up. Fat liquefaction and delayed healing of the posterior wound occurred in 1 patient. Cerebrospinal fluid leakage occurred in another patient. There was no neurologic deterioration and no procedure-related complications.Anterior release and nonstructural bone grafting combined with posterior fixation provides a safe and effective option for treating old lower cervical dislocations with locked facets.
下颈椎脱位在初次受伤时常常因多种原因而被漏诊。下颈椎陈旧性小关节脱位的治疗困难，尚未确立最佳治疗方法。本研究的目的是评估一种手术技术——前路松解、非结构性植骨联合后路固定——治疗伴有小关节交锁的下颈椎陈旧性脱位的临床疗效。
这是一项对17例（13例男性和4例女性）陈旧性小关节脱位患者的回顾性研究，这些患者于2010年4月至2016年1月在我院接受了相同的手术治疗。前路手术用于清除融合块、进行椎间盘切除术和碎骨植骨。随后的后路手术包括松解、复位和后路融合。记录并评估术前和术后的神经功能状态、临床数据（日本骨科协会[JOA]评分、颈部功能障碍指数[NDI]和视觉模拟量表[VAS]评分）以及影像学信息（局部矢状面排列和植骨融合情况）。
所有患者术中均实现了近乎完全复位。平均手术时间为178±49分钟。平均失血量为174±73毫升。每位患者至少完成了12个月的随访。平均随访时间为32.6±18.5个月。末次随访时，根据Frankel分级的神经功能状态显著改善。与术前值相比，JOA、NDI和VAS评分均显示出显著改善（P<0.05）。脱位节段的后凸角术前为10.5±5.9°，术后矫正为5.9±4.3°的前凸。随访12个月内所有患者均观察到前路和后路牢固融合。1例患者出现后伤口脂肪液化和延迟愈合。另1例患者发生脑脊液漏。未出现神经功能恶化及与手术相关并发症。
前路松解、非结构性植骨联合后路固定为治疗伴有小关节交锁的下颈椎陈旧性脱位提供了一种安全有效的选择。
