Ostl O L, Fraser R D, Griffiths E R
Department of Orthopaedic Surgery and Trauma, Royol Adelaide Hospital, South Australia.
J Bone Joint Surg Br. 1989 Mar;71(2):275-82. doi: 10.1302/0301-620X.71B2.2925746.
We compared retrospectively consecutive series of patients with cervical dislocation treated at two Australian centres. In Perth, 82 patients were treated by closed reduction and postural nursing. In Adelaide, 85 patients had closed reduction and early surgical stabilisation by interbody fusion. There were 46 bilateral dislocations, 101 unilateral dislocations, and 20 anterior subluxations. On admission 30 patients had complete tetraplegia, 17 incomplete tetraplegia, and 120 had minimal or no neurological loss. Our results indicated that closed manipulation under general anaesthesia is a safe and effective means of reduction in the acute stage. There was a high mortality rate for acute surgery in patients with complete tetraplegia. Early surgical stabilisation by dowel fusion reduced bed and hospital stay in patients with no neurological loss, but seemed to impair neurological recovery in patients with a neurological deficit on admission. Conservative management after reduction of bilateral dislocation or anterior subluxation led to a higher incidence of instability in patients with minimal or no neurological loss; in such cases surgery to stabilise the injured segment is indicated.
我们回顾性比较了澳大利亚两个中心治疗的颈椎脱位连续系列患者。在珀斯，82例患者接受了闭合复位和体位护理。在阿德莱德，85例患者接受了闭合复位并通过椎间融合进行早期手术稳定。共有46例双侧脱位、101例单侧脱位和20例前半脱位。入院时，30例患者为完全性四肢瘫，17例为不完全性四肢瘫，120例神经功能丧失轻微或无神经功能丧失。我们的结果表明，全身麻醉下的闭合手法复位是急性期安全有效的复位方法。完全性四肢瘫患者急性手术的死亡率很高。对于无神经功能丧失的患者，通过植骨融合进行早期手术稳定可缩短卧床和住院时间，但似乎会损害入院时存在神经功能缺损患者的神经功能恢复。双侧脱位或前半脱位复位后进行保守治疗，神经功能丧失轻微或无神经功能丧失的患者不稳定发生率较高；在这种情况下，建议进行手术以稳定受伤节段。
