Lu K, Lee T C, Chen H J
Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Acta Neurochir (Wien). 1998;140(10):1055-61. doi: 10.1007/s007010050214.
Bilateral facet interlocking of the cervical spine is a relatively uncommon type of cervical spinal injury. It is frequently associated with devastating neurological symptoms and signs. Early reduction of the locked facets is thought to be critical in preventing progressive secondary spinal cord injury. Whereas skull tong traction remains our primary option for closed reduction of bilateral locked facets of the cervical spine, it is not always successful, even with heavy traction weights. Other more aggressive measures may occasionally be required. The authors report their experience in reducing bilateral locked facets of the cervical spine by manual closed reduction.
This small series consists of six cases of cervical spinal injury with bilateral locked facets in which manual closed reduction under general anaethesia and muscle relaxation was used. Three of them presented with complete quadriplegia (Frankel class A). One case presented with incomplete but severe neurological deficits (Frankel class B). After unsuccessful closed reduction with skull traction, these patients were treated by manual closed reduction under general anaesthesia and muscle relaxation, followed by anterior discectomy, interbody fusion and stabilization.
All cases made neurological improvement after the procedures. Even in cases with initial severe neurological deficits, the recovery was remarkable. The recovery was dramatic in two cases. Case 1 improved from Frankel class B to E; and Case 5 from Frankel class A to D. No case deteriorated neurologically after the procedures. Pneumonia occurred in Case 3; and stress ulcer accompanied by haemorrhage was noted in Case 4. None of these complications was directly related to the procedures.
The potential for improvement of neurological function following early and successful reduction and fixation of the dislocated spine is emphasized. With meticulous techniques, manual closed reduction may be an effective alternative to skull tong traction when the latter fails.
颈椎双侧小关节交锁是一种相对少见的颈椎损伤类型。它常伴有严重的神经症状和体征。早期复位交锁的小关节被认为对预防继发性脊髓损伤的进展至关重要。虽然颅骨牵引仍然是我们闭合复位颈椎双侧小关节交锁的主要选择，但即使使用较大的牵引重量，也并非总能成功。有时可能需要采取其他更积极的措施。作者报告了他们通过手法闭合复位治疗颈椎双侧小关节交锁的经验。
本小系列包括6例颈椎双侧小关节交锁损伤患者，采用全身麻醉和肌肉松弛下的手法闭合复位。其中3例表现为完全性四肢瘫（Frankel A级）。1例表现为不完全但严重的神经功能缺损（Frankel B级）。在颅骨牵引闭合复位失败后，这些患者接受了全身麻醉和肌肉松弛下的手法闭合复位，随后进行前路椎间盘切除、椎间融合和内固定。
所有病例术后神经功能均有改善。即使是最初有严重神经功能缺损的病例，恢复也很显著。有2例恢复情况惊人。病例1从Frankel B级改善为E级；病例5从Frankel A级改善为D级。术后无病例神经功能恶化。病例3发生了肺炎；病例4出现了伴有出血的应激性溃疡。这些并发症均与手术无直接关系。
强调了早期成功复位和固定脱位脊柱后神经功能改善的可能性。当颅骨牵引失败时，采用精细的技术，手法闭合复位可能是一种有效的替代方法。
