前路手术治疗下颈椎骨折脱位并脊髓损伤临床效果

杨淑奎

（陕西省康复医院，陕西 西安，710065）

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摘要：

目的 探讨前路手术治疗下颈椎骨折脱位并脊髓损伤临床效果。方法 选取2012年3月至2016年2月我院收治的212例下颈椎骨折脱位伴脊髓损伤患者为研究对象。所有患者均给予前路手术治疗，观察所有患者的临床效果。结果 212例患者 中，182例患者获得随访，随访时间为19～53 个月，平均31个月，随访失败10例，死亡20例。212例接受前路手术治疗的下颈椎骨折脱位并脊髓损伤患者中，166例均完全复位，46例在术中复位，牵引成功率78.30%。182例随访成功的患者在经过前路手术治疗后，显效138例（75.82%），有效43 例（23.63%），无效1例（0.72%），总有效率为99.45%。患者术后脊髓神经功 能提高1～2级，其中恢复至B级76例，C级94例，D级12例。手术后，3 例患者出现声音嘶哑并伴有吞咽困难，使用营养药进行治疗后，7 天左右恢复；13例患者出现呼吸困难，通过气管插管、呼吸机辅助治疗后，7 天左右好转；19例患者并发肺部感染，经过抗炎、吸氧、糜蛋白酶雾化治疗，7 天左右恢复。结论 通过前路手术治疗下颈椎骨折脱位并脊髓损伤能使颈椎获得稳定，临床效果显著。

关键词：下颈椎；骨折；脱位；脊髓损伤；前路手术

中图分类号：R687.3文献标志码：A文章编号：2096-1413(2017)27-0069-02

Clinical effect of anterior cervical operation in the treatment of fracture and dislocation of lower cervical spine combined with spinal cord injury
YANG Shu-kui
(Shaanxi Kangfu Hospital, Xi``an 710065, China)

ABSTRACT: Objective To investigate the clinical effect of anterior cervical operation in the treatment of fracture and dislocation of lower cervical spine combined with spinal cord injury. Methods A total of 212 cases of patients with lower cervical spine combined with spinal cord injury admitted in our hospital from March 2012 to February 2016 were selected as the study objects. All the patients were treated with anterior cervical operation, the clinical effect was observed. Results In 212 lower cervical spine combined with spinal cord injury patients, 182 patients were followed up for 19~53 months, with an average of 31 months, 10 patients lost the follow -up and 20 died. Among the 212 patients, 166 patients were completely reset, and 46 patients were reset during operation, the success rate of traction was 78.30%. In 182 patients with successful follow-up, 138 cases were markedly effective (75.82%), effective in 43 cases (23.63%), ineffective in 1 case (0.72%), and the total effective rate was 99.45%. The patients`` neurological function of spinal cord improved by 1~2 grade, of which 76 cases recovered to grade B, 94 cases in grade C, 12 cases in grade D. After surgery, 3 patients occurred hoarseness and dysphagia, 7 days recovered after using nutrition treatment; 13 patients occured dyspnea, the patients improved by endotracheal intubation and ventilator assisted treatment; 19 patients complicated with pulmonary infection, all of them recovered after anti -inflammatory, oxygen inhalation, and chymotrypsin atomization treatment for 7 days. Conclusion Anterior cervical operation in the treatment of fracture and dislocation of lower cervical spine combined with spinal cord injury can make the patients`` cervical spine stable, which has remarkable clinical effects.
KEYWORDS: lower cervical spine；fracture; dislocation; spinal cord injury; anterior cervical operation

参考文献：
[1] 梁正忠,陈在飞,廖相波,等.下颈椎骨折脱位并颈脊髓损伤早期前路手术治疗效果分析[J].中国实用医药,2013,8(11):62-63.
[2] 张芳,马戈东,张会凡.颈椎前路手术治疗颈椎骨折脱位并发脊髓损伤的围手术期护理[J].中医正骨,2014,26(6):79-80.
[3] 郝定均,贺宝荣,许正伟.下颈椎骨折脱位并脊髓损伤的前路手术治疗[J].中国脊柱脊髓杂志,2013,7(7):266-268.
[4] 柳志泽.下颈椎骨折脱位合并脊髓损伤前后路手术的选择及疗效评价[D].大连:大连医科大学,2013.
[5] 朱甲麟,贺西京.脊髓损伤患者流行病学调查和相关因素分析[C]// 全国脊髓损伤治疗与康复研讨会.2012.
[6] 陶海南,蒋守念,方钢,等.手术治疗下颈椎骨折脱位并脊髓损伤68例临床分析[J].中国临床新医学,2010,3(4):371-373.
[7] 张岱阳,罗政.高粘度与低粘度骨水泥在PVP 治疗骨质疏松椎体骨折的疗效分析[J].中南医学科学杂志,2016,44(4):371-375.