【摘要】：目的：探討下頸椎陳舊性小關(guān)節(jié)損傷的治療策略與療效。 方法：回顧性研究2010年1月-2014年1月，手術(shù)治療陳舊性頸椎小關(guān)節(jié)損傷患者36例。其中男29例，女7例；年齡21-62歲，平均年齡36.4歲。受傷至就診時(shí)間23天-4個(gè)月，平均40.6天。根據(jù)Kotani側(cè)塊及關(guān)節(jié)突關(guān)節(jié)骨折分型，分離型19例，粉碎性骨折4例，劈裂型骨折10例，創(chuàng)傷性椎體滑脫3例。術(shù)前術(shù)后通過Frankel及JOA評(píng)分系統(tǒng)評(píng)價(jià)損傷程度和術(shù)后恢復(fù)情況。 結(jié)果：所有患者均行手術(shù)治療，其中后入路椎弓根釘棒系統(tǒng)內(nèi)固定手術(shù)6例，后-前-后聯(lián)合入路椎弓根釘棒系統(tǒng)內(nèi)固定手術(shù)4例，前入路自體骨融合鎖定鈦板內(nèi)固定手術(shù)26例。隨訪6個(gè)月至2年，平均隨訪13.9個(gè)月。Frankel評(píng)分術(shù)后改善1級(jí)18例，改善2級(jí)17例，改善3級(jí)1例。JOA改善率57.1%-92.3%，平均75.3%。隨訪6個(gè)月，融合節(jié)段均獲得骨性愈合，無鋼板、螺釘、釘棒松動(dòng)斷裂等并發(fā)癥。 結(jié)論：下頸椎陳舊性小關(guān)節(jié)損傷手術(shù)治療的關(guān)鍵是后路對(duì)絞鎖的關(guān)節(jié)突的松解及解剖復(fù)位。分離型、粉碎性和劈裂型陳舊性小關(guān)節(jié)損傷，，需要依據(jù)患者神經(jīng)壓迫情況選擇術(shù)式；創(chuàng)傷性椎體滑脫型陳舊性損傷，首選單純后入路頸椎復(fù)位內(nèi)固定，術(shù)中決定是否追加前路再松解植骨融合，并同期后路內(nèi)固定。
[Abstract]:Objective: to investigate the treatment strategy and curative effect of old facet joint injury of lower cervical spine. Methods: from January 2010 to January 2014, 36 patients with old cervical facet joint injury were treated surgically. There were 29 males and 7 females, aged 21-62 years, with an average age of 36.4 years. The time from injury to consultation was 23 days-4 months, with an average of 40.6 days. According to the classification of Kotani lateral mass and articular facet fracture, there were 19 cases of separate type, 4 cases of comminuted fracture, 10 cases of split fracture and 3 cases of traumatic spondylolisthesis. The degree of injury and postoperative recovery were evaluated by Frankel and JOA scoring system before and after operation. Results: all the patients were treated by operation, including 6 cases of posterior pedicle screw and rod system fixation, 4 cases of posterior anterior posterior combined approach pedicle screw rod system internal fixation. Anterior approach autogenous bone fusion locking titanium plate fixation in 26 cases. The patients were followed up for 6 months to 2 years and followed up for an average of 13.9 months. There were 18 cases of grade 1 improvement, 17 cases of improvement of grade 2 and 1 case of improvement of grade 3 after Frankel scoring. The improvement rate of JOA was 57.1% -92.3% (mean 75.3%). Follow up for 6 months showed that bone healing was achieved in fusion segment without complications such as steel plate screw loosening fracture and so on. Conclusion: the key to the surgical treatment of the old facet joint injury of the lower cervical spine is the release and anatomical reduction of the strangulated articular process. Separation type, comminuted type and split type old facet joint injury, need to choose according to the patient's nerve compression condition. Traumatic spondylolisthesis type old injury, the first choice is simple posterior approach cervical spine reduction and internal fixation, during the operation decide whether to add anterior approach and release bone graft fusion, and at the same time, posterior internal fixation.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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