本文選題：齒狀突骨折 + 頸髓損傷　； 參考：《中國修復(fù)重建外科雜志》2017年08期

【摘要】：目的探討齒狀突骨折合并無骨折脫位型下頸髓損傷的特點(diǎn)、機(jī)制和診治策略。方法回顧分析2007年6月—2015年10月收治的符合選擇標(biāo)準(zhǔn)的7例齒狀突骨折合并無骨折脫位型下頸髓損傷患者臨床資料�；颊呔鶠槟行�,年齡37~71歲,平均51.4歲。致傷原因:交通事故傷2例,摔傷2例,擊打傷3例。受傷至入院時間2 h~3 d,平均9 h。齒狀突骨折采用Anderson-Grauer分型,ⅡA型1例,ⅡB型3例,ⅡC型2例,淺Ⅲ型1例。頸髓損傷受累節(jié)段:C_(4、5) 1例,C_(4~6) 2例,C_5~7 4例。頸椎退變程度:輕度2例,中度3例,重度2例。無骨折脫位型下頸髓損傷采用下頸椎損傷分型系統(tǒng)評分(SLIC)為4~6分,平均5.1分。枕頸部疼痛采用疼痛視覺模擬評分(VAS)為(7.8±1.0)分。神經(jīng)功能采用ASIA分級,B級1例,C級4例,D級2例;日本骨科協(xié)會(JOA)評分為(9.2±3.9)分。齒狀突骨折采用前路螺釘固定術(shù)4例,后路寰樞椎固定融合術(shù)3例;下頸髓損傷采用前路椎體次全切除鈦網(wǎng)植骨融合術(shù)4例,椎間盤切除Cage植骨融合術(shù)3例。結(jié)果手術(shù)時間178~252 min,平均210.2 min;術(shù)中出血量60~140 m L,平均96.5 m L,均未輸血。術(shù)后切口均Ⅰ期愈合。7例患者均獲隨訪,隨訪時間12~66個月,平均18個月。均未出現(xiàn)與頸椎手術(shù)直接相關(guān)的并發(fā)癥。術(shù)后植骨均完全融合,融合時間6~9個月,平均7.7個月。隨訪期間未見內(nèi)固定物松動、脫落。末次隨訪時枕頸部疼痛VAS評分為(1.7±0.7)分,JOA評分為(15.1±1.7)分,均較術(shù)前顯著改善(t=18.064,P=0.000;t= 7.066,P=0.000)。末次隨訪時神經(jīng)功能ASIA分級為D級5例,E級2例,與術(shù)前比較差異有統(tǒng)計學(xué)意義(Z= 2.530,P=0.011)。結(jié)論復(fù)合暴力和下頸椎退變是齒狀突骨折合并無骨折脫位型下頸髓損傷的主要原因,依據(jù)齒狀突骨折的類型與下頸髓的損傷狀態(tài)制定并實施一期手術(shù)可獲滿意療效。
[Abstract]:Objective to investigate the characteristics, mechanism, diagnosis and treatment of cervical spinal cord injury without fracture and dislocation of odontoid process fracture. Methods from June 2007 to October 2015, 7 patients with odontoid process fracture with no fracture and dislocation were retrospectively analyzed. The clinical data of 7 patients with cervical spinal cord injury without fracture and dislocation were analyzed retrospectively. All the patients were male, aged 3771 years (mean 51.4 years). The causes of injury were traffic accident in 2 cases, fall in 2 cases and hit injury in 3 cases. The time from injury to admission was 2 hours and 3 days, with an average of 9 hours. Anderson-Grauer classification was used for odontoid fracture. Type 鈪，

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