作　　者： (汤冀强）; (苏学涛）; (孙明林）; (唐锋明）; (袁斌斌）; (韩岳）; (张继东）; (夏群）;

机构地区： 武警后勤学院附属医院脊柱外科,天津300162

出　　处： 《中华创伤杂志》 2017年第9期779-784,共6页

摘　　要： 目的探讨“沙滩椅体位”Ⅰ期前后联合入路手术治疗复杂下颈椎骨折脱位的可行性及临床疗效。方法采用回顾性病例系列研究分析2012年5月-2016年5月收治的16例严重下颈椎骨折脱位患者临床资料，均为男性；年龄36—78岁，平均49．8岁。损伤节段：C4-5 4例，C5-7例，C6-7 5例；美国脊髓损伤协会（ASIA）分级：A级4例，B级7例，C级5例；下颈椎损伤分类（SLIC）评分：8分9例，9分7例。手术均在全身麻醉下进行，采用“沙滩椅体位”，Halo头环牵引悬吊头颈部，常规颈椎前、后路入路，先后方置入椎弓根螺钉或侧块螺钉，再前路切除损伤椎间盘或部分骨折椎体；前后路协同复位，前方置入椎间融合器或钛网支撑植骨，后方将椎弓根螺钉或侧块螺钉加压固定并植骨融合。术中监测呼气末二氧化碳分压（PETCO2），观察是否发生“空气栓塞”；记录手术时间、术中出血量。观察伤口愈合情况；根据ASIA分级评估神经功能恢复情况；术后定期复查了解内置物位置、骨折脱位复位及植骨融合情况。结果手术均顺利完成，未发生如“空气栓塞”等与“沙滩椅体位”相关并发症。手术时间150—180min，平均153min；术中出血量400—800ml，平均543ml。患者均获随访6—24个月，平均13．7个月。伤口均I期愈合。术后无脊髓损伤加重，术后6个月，除ASIA分级为A级患者较术前无变化外，其余患者ASIA分级较术前平均提高1～2级。术后复查颈椎x线片及CT示内置物位置良好，颈椎序列恢复正常；Cobb角由术前（23．6±5．3）°恢复至（4．0±0．4）°，椎体水平位移由术前（10．9±1．6）mm恢复至（2．7±0．4）mm（P〈0．01）；颈椎MRI示颈椎管通畅，颈脊髓压迫解除。结论“沙滩椅体位”I期前后联合入路手术治疗严重下颈椎骨折脱位复位效果、神经功能恢复均良好，具有协同复位固定、术 Objective To explore the surgical feasibility and clinical efficacy of one-stage anteri-or-posterior approaches in treatment of severe fracture and dislocation of lower cervical spine in ＂beach chair position＂. Methods Sixteen male cases of severe fracture and dislocation of lower cervical spine and with a mean age of 49.8 years （range, 36-78 years） treated surgically from May 2012 to May 2016 were analyzed retrospectively by using case series study. The segment of injury was C4-5 in 4 cases, C5-6 in 7 and C6-7 in 5. The degree of spinal cord injury according to the American Spine injury Association （ASIA） score was Grade A in 4 cases, Grade B in 7 and Grade C in 5. Sub-axial injury classification （SLIC） score was 8 points in 9 cases and 9 points in 7. After a general anesthesia, a ring with a hole was hanged on patient＇s head before the operation. Then, under the protection of hole traction, the upper of operating bed was swung up slowly, so that the patient was restricted in vertical ＂beach chair position＂ with traction on the halo in order to immobilize the head and partially reduce the kyphotic deformity. Routine cervical anterior-posterior approach was done with the exposure of damaged section of the front and rear structure. Pedicle screw system or lateral mass screw displacement was conducted. Anterior intervertebral discectomy or fracture vertebral was performed, using collaborative reset prying method before and after the road. In the front of intervertebral cage or titanium net support bone graft, rear pedicle screws or lateral mass screws fixation and bone graft fusion were implemented. The operation time and blood loss were recorded. The healing of the wound was observed. The recovery of neurological function was evaluated according to the ASIA grade. Postoperative review X-ray, CT and MRI were done to evaluate the reset and bone graft in position and fusion. Results All the surgeries were done well without aeroembolism and other related complications. The mean operative time was

关 键 词： 颈椎 脊柱骨折 脱位 沙滩椅体位