2018 年第 9 期 第 13 卷

过屈型颈椎损伤并发前部脊髓综合征术式选择与疗效评价

Surgical strategy and prognosis evaluation of cervical hyperflexion injury with anterior spinal cord syndrome

作者：张艳魏威张洪梅李谷李建华张军军关维俊

英文作者：

单位：063000河北省唐山市第二医院院长办公室（张艳），护理服务中心（李谷），手术室（李建华），脊柱三科（张军军）；063000河北省唐山市人民医院骨科（魏威）；063000河北省唐山市，华北理工大学临床医学院（张洪梅），公共卫生学院（关维俊）

英文单位：

关键词：过屈型颈椎损伤；前部脊髓综合征；骨科手术；预后评价

英文关键词：

• 摘要：

• 【摘要】目的    探讨过屈型颈椎损伤并发前部脊髓综合征的不同手术治疗方式并评价其疗效。方法    收集2015年1月至2017年4月于河北省唐山市第二医院治疗的过屈型颈椎损伤并发前部脊髓综合征39例患者的病历资料。所有患者根据不同病情分别采取不同手术治疗方式，观察术前及术后1年随访日本骨科协会评分变化以评价疗效。结果    对于单纯前脱位经颅骨牵引复位后能够稳定的，或无骨折脱位但有椎间盘损伤突出的患者，选择颈椎前路手术，摘除损伤的椎间盘，取自体髂骨或椎间融合器植骨，行蝶形钢板内固定术。对于椎体骨折患者，经颅骨牵引复位稳定后选用经前路伤椎次全切除，取自体髂骨或钛网植骨，行蝶形钢板内固定术。对于合并关节突关节骨折、椎板骨折或小关节嵌顿无法经牵引复位或复位后仍不稳定患者，选择联合后路切开复位椎板减压侧块钢板或椎弓根钉棒系统内固定术。对于合并黄韧带肥厚、后纵韧带骨化或存在发育性椎管狭窄的患者，选择前路手术同时联合相应的后路手术。所有患者随访期间骨折脱位均经手术复位固定效果满意，均无感染、内固定失败等严重并发症。39例患者术后1年随访日本骨科协会总分明显高于术前［（6.02±1.45）分比（2.74±0.58）分］，差异有统计学意义（P＜0.05）。结论    对于过屈型颈椎损伤并前部脊髓综合征的患者，应根据受伤机制、影像学病理特征及临床症状的不同，有针对性地选择合理的手术方法，可使患者获得理想预后。

• 【Abstract】Objective    To observe the therapeutic effect of different surgical treatments on cervical hyperflexion injury with anterior spinal cord syndrome. Methods    Clinical records of 39 cases of cervical hyperflexion injury with anterior spinal cord syndrome in the Second Hospital of Tangshan were collected from January 2015 to April 2017. The patients were treated with different surgical methods according to individual conditions. Japanese Orthopedics Association(JOA) score was observed before and 1 year after operation to evaluate the surgical effect. Results    Patients with simple anterior dislocation after cranial traction reduction and patients with intervertebral disc injury without fracture dislocation were treated with anterior cervical surgery to remove the injured disc; autogenous iliac bone or interbody fusion apparatus was used for internal fixation. Patients with vertebral fracture were treated with cranial traction and anterior subtotal vertebral body resection; autogenous iliac bone or titanium mesh was used for internal fixation. For patients with facet joint fracture, vertebral plate fracture or facet incarceration that can not be treated with traction reduction, combined posterior open reduction and laminectomy decompression, lateral plate or pedicle screw internal fixation were optional operation choice. Patients with hypertrophy of ligamentum flavum, ossification of posterior longitudinal ligament or developmental spinal stenosis should have combined anterior and posterior approach surgery. All fractures and dislocations recovered well after surgery; no serious complications such as infection and internal fixation failure was observed during follow-up. In 39 patients, the total score of JOA at 1-year after surgery was significantly higher than that before surgery［（6.02±1.45） vs （2.74±0.58）］（P＜0.05）. Conclusion    Surgical strategy of cervical hyperflexion injury with anterior spinal cord syndrome should be chosen according to the injury type, imaging features and clinical manifestations; patients will have good prognosis after optional surgery.