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颈椎侧块钢板螺钉内固定术治疗下颈椎骨折脱位 |
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孙宇 王超 党耕町 王少波 齐强 王志国
【摘要】目的应用颈椎侧块钢板螺钉内固定术治疗下颈椎骨折脱位。方法应用此项技术治疗下颈椎骨折脱位22例。其中单侧小关节骨折脱位3例，双侧10例；单侧小关节脱位4例，双侧1例；双侧小关节脱位合并椎体压缩骨折2例；双侧小关节骨折脱位合并椎体裂纹骨折1例；椎体爆裂型骨折1例。无神经系统损伤者3例，仅合并神经根损伤者7例，合并脊髓损伤者12例（完全性6例，不完全性6例）。切开复位，将螺钉固定于颈椎侧块上，配以钢板连接和植骨，实现坚强固定。结果本组22例平均随访34个月（10个月～7年2个月），平均融合时间为3.5个月，术后平均3.3d可在围领保护下从床上坐起。仅合并神经根损伤的患者平均术后7d离床活动,围领保护平均11.2周，平均3.5个月恢复原工作或劳动。合并脊髓损伤的12例中，6例不完全性损伤者，根性症状明显减轻，脊髓功能稍有改善（Frankel分级提高1级）。术中无血管、神经系统损伤。1例术中复位不完全，2例（共4枚）螺钉松动，但均未影响症状的减轻及融合效果。结论本术式具有短节段固定、稳定作用强、术后仅需轻便外固定、可早期活动等优点。
【关键词】颈椎；骨折；脱位；骨板
The use of cervical lateral mass plate and screw for the treatment of fracture and dislocation of the lower cervical spine
SUN Yu, WANG Chao, DANG Gengting, et al.
（Department of Orthopaedics， The Third Teaching Hospital of Beijing Medical University, Beijing 100083, China）
【 Abstract】 Objective The cervical lateral mass plate and screw were used for the treatment of fracture and dislocation of the lower cervical spine. Methods 22 cases of lower cervical spine injury were treated by this technique from December 1991 to March 1997. There were 3 unilateral and 10 bilateral facet fractures and dislocations, 1 bilateral and 4 unilateral facet dislocations. 3 bilateral facet dislocations were associated with vertebral body fracture. 3 cases were neurologically intact. 7 were complicated with single or multiple nerve root injuries. 6 had incomplete and 6 complete spinal cord injury. The screws and plates were placed on the lateral mass of cervical vertebrae by using Roy－ Camille (16 cases), and Margel or AO techniques (6 cases).Lamina or facet bone grafting was performed to achieve a long-term stability. Results The follow-up ranged from 10 months to 7 years and 2 months (mean 34 months). All the cases had solid fusion based on flexion and extension radiographs at an average of 3.5 months. Patients were encouraged to sit up wearing soft collar 3.3 days (1－ 7 days) after the surgery. 7 of 22 cas[1] [2] [3] 下一页
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