Blauth M, Knop C, Bastian L, Schmidt U
Unfallchirurgische Klinik, Medizinische Hochshule Hannover.
Zentralbl Chir. 1998;123(8):894-906.
Prerequisites for successful reduction of cervical spine injuries are an exact analysis and classification of every lesion. In locked dislocations disc protrusion should be excluded prior to reduction by MRI or CT-scan. For manual reduction and closed manipulation by the trauma surgeon we use a halo-ring which is applied in local anaesthesia and fluoroscopic control. The anatomic position is maintained by a halo-fixator until surgery. Skeletal traction is used mainly for locked dislocations and late malalignements. Traction is provided by a halo-ring and weights up to 20 kg. Repeated clinical and neurological examinations are necessary to rule out overdistraction of the spine or neurologic deterioration. The weight may be reduced after reduction to 2 kg. For intraoperative positioning and reduction of cervical spine injuries we designed a special device which is connected to the halo ring and allows to fix the head and spine in any desired position. It may be used in prone or supine position of the patient. Operative reductions are rarely necessary on the cervical spine. Typical indication are fractures of posterior elements of the spine preventing closed reduction. Reduction manoeuvers depend on the kind of injury and are mainly composed of traction and a reversal of the trauma mechanism. The most severe complication is a neurologic deterioration. Reports in literature about 13 patients having sustained such a fate are showing the following: In most cases disc material dislocated in the spinal canal during reduction could be made responsible for the catastrophic course. Especially at risk are patients with open reduction from a posterior approach.
成功复位颈椎损伤的前提是对每处损伤进行准确分析和分类。对于锁定性脱位，在复位前应通过MRI或CT扫描排除椎间盘突出。对于创伤外科医生进行的手法复位和闭合操作，我们使用在局部麻醉和透视控制下应用的头环。在手术前，通过头环固定器维持解剖位置。骨骼牵引主要用于锁定性脱位和晚期错位。牵引由头环和重达20公斤的重物提供。需要反复进行临床和神经学检查，以排除脊柱过度牵引或神经功能恶化。复位后重物可减至2公斤。为了在术中对颈椎损伤进行定位和复位，我们设计了一种特殊装置，该装置与头环相连，可将头部和脊柱固定在任何所需位置。它可用于患者的俯卧位或仰卧位。颈椎很少需要进行手术复位。典型的适应证是脊柱后部结构骨折，妨碍闭合复位。复位手法取决于损伤类型，主要包括牵引和创伤机制的逆转。最严重的并发症是神经功能恶化。文献中关于13例患者遭遇这种情况的报道如下：在大多数情况下，复位过程中椎管内脱位的椎间盘物质可能是灾难性病程的原因。尤其是采用后路切开复位的患者风险更高。
