[1]陈海龙,郑九琴,朱文潇,等.常规颅骨牵引和全身麻醉下手法复位在下颈椎脱位前路减压植骨融合内固定术中的应用[J].中医正骨,2017,29(07):74-76,79.
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常规颅骨牵引和全身麻醉下手法复位在下颈椎脱位前路减压植骨融合内固定术中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年07期
页码:
74-76,79
栏目:
临床报道
出版日期:
2017-07-20

文章信息/Info

作者:
陈海龙; 郑九琴; 朱文潇; 马俊杰; 张红星
河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002
关键词:
颈椎;  脱位;  牵引术;  正骨手法;  麻醉; 全身
摘要:
目的:探讨常规颅骨牵引和全身麻醉下手法复位在下颈椎脱位前路减压植骨融合内固定术中的作用及安全性。方法:2014年5月至2016年3月,对行前路减压植骨融合内固定术的26例新鲜下颈椎脱位患者,采用常规颅骨牵引和全身麻醉下手法复位; 男17例,女9例; 年龄21～75岁,中位数48岁; C4～C5脱位7例、C5～C6脱位14例、C6～C7脱位5例; 单纯脱位20例,脱位伴骨折6例; 双侧关节突关节交锁19例,单侧关节突关节交锁7例; 根据脊髓损伤的Frankel分级,A级5例、B级7例、C级9例、D级4例、E级1例。受伤至就诊时间4～28 h,中位数19 h。术后随访观察椎体复位、植骨融合、椎间高度恢复、并发症发生及脊髓功能恢复情况。结果:所有患者均获随访,随访时间4～24个月,中位数12个月; 椎体均复位良好,植骨均获得骨性融合,椎间高度均得以恢复; 均无血管损伤、气管损伤、食管损伤、脊髓损伤、椎体再脱位及螺钉松动、断裂等并发症发生。脊髓神经功能Frankel分级A级5例、B级5例、C级5例、D级6例、E级5例。结论:行前路减压植骨融合内固定术治疗下颈椎脱位前,采用常规颅骨牵引和全身麻醉下手法复位,创伤小,可实现颈椎即时复位,且复位成功率高,椎间植骨融合率高,能恢复椎间高度,有利于脊髓神经功能的恢复,并发症少,值得临床推广使用。

参考文献/References:

[1] 张广泉,李琳,高延征,等.下颈椎骨折脱位伴关节突绞锁的治疗策略[J].中华创伤骨科杂志,2013,15(9):810-812.
[2] RASOULINEJAD P,MCLACHLIN SD,BAILEY SI,et al.The importance of the posterior osteoligamentous complex to subaxial cervical spine stability in relation to a unilateral facet injury[J].Spine J,2012,12(7):590-595.
[3] FRANKEL HL,HANCOCK DO,HYSLOP G,et al.The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia[J].Paraplegia,1969,7(3):179-192.
[4] 姚关锋,王新家,王伟东,等.Halo-vest支架复位联合前路减压内固定治疗下颈椎骨折脱位[J].中华创伤杂志,2015,31(8):695-698.
[5] CONI V,GOPINATHAN NR,KRISHNAN V,et al.Management of neglected cervical spine dislocation:a study of six cases[J].Chin J Tranmatol,2013,16(4):212-215.
[6] SULLIVAN MP,MCCORMICK JD,ARLET V.Vertebral artery injury and severely displaced odontoid fracture: the case for early reduction[J].Eur Spine J,2013,22(10):2149-2153.
[7] 李玉伟,严晓云,王海蛟,等.颈前路先减压后复位治疗下颈椎脱位临床观察[J].中华医学杂志,2015,95(41):3384-3386.
[8] MOBBS RJ,LOGANATHAN A,YEUNG V,et al.Indications for anterior lumbar interbody fusion[J].Orthop Surg,2013,5(3):153-163.
[9] CHEN Y,WANG X,CHEN D,et al.Surgical treatment for unilateral cervical facet dislocation in a young child aged 22 months old:a case report and review of the literature[J].Eur Spine J,2013,22(Suppl 3):S439-S442.
[10] KRAUEL J,WINKLER D,MüNSCHER A,et al.Laryngeal dislocation after ventral fusion of the cervical spine[J].Indian J Anaesth,2013,57(3):285-288.
[11] 周方,田云,姬洪全,等.Ⅰ期全身麻醉下快速牵引复位及前路减压融合治疗下颈椎脱位[J].中华创伤杂志,2005,21(z1):26-29.
[12] GUPTA P,KUMAR A,GAMANGATTI S.Mechanism and patterns of cervical spine fractures-dislocations in vertebral artery injury[J].J Craniovertebr Junction Spine,2012,3(1):11-15.
[13] LEE JY,NASSR A,ECK JC,et al.Controversies in the treatment of cervical spine dislocations[J].Spine J,2009,9(5):418-423.
[14] GRANT GA,MIRZA SK,CHAPMAN JR,et al.Risk of early closed reduction in cervical spine subluxation injuries[J].J Neurosurg,1999,90(1 Suppl):13-18.
[15] VACCARO AR,FALATYN SP,FLANDERS AE,et al.Magnetic resonance evaluation of the intervertebral disc,spinal ligaments,and spinal cord before and after closed traction reduction of cervical spine dislocations[J].Spine(Phila Pa 1976),1999,24(12):1210-1217.

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更新日期/Last Update: 2017-12-29