Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5-to 15-Year Follow-Up
Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5-to 15-Year Follow-Up
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DOI：
10.1016/j.wneu.2018.03.213
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发表时间：
2018-07-01
影响因子：
2
通讯作者：
Kong, Lingbo
中科院分区：
文献类型：
--
作者：
Gao, Wenjie;Wang, Biao;Kong, Lingbo
背景：下颈椎骨脱位常与脊髓损伤同时发生。对于最佳治疗方案没有明确的共识。直接减压和复位的前路手术已被广泛接受。方法：回顾性分析2001年1月至2011年1月312例下颈椎骨折脱位合并脊髓损伤患者行前路手术治疗的临床资料。在312例患者中，218例（70%; 121例男性和97例女性）符合入选标准。根据脊柱后凸Cobb角、颈功能障碍指数和日本骨科协会评分，采用Odom标准和统计学分析评价临床疗效。神经功能恢复的患者进行了评估，由美国脊髓损伤协会system.Results：平均随访时间为8.9 +/- 2.9年（范围，5-15年）。后凸角和颈部残疾指数以及日本矫形协会评分从术前的10.6度± 8.9度和39.7 ± 4.3和7.6 ± 2.4显著变化为末次随访的-5.2度± 8.6度和10.8 ± 4.6和15.6 ± 1.2（P < 0.05）。在这些患者中，197例（90.4%）结局为良好至极佳，14例（6.4%）结局满意，7例（3.2%）结局较差。218例患者中143例（65.6%）神经功能得到不同程度的恢复，191例患者中140例（73.3%）出现不完全性瘫痪。结论：对于下颈椎脱位合并脊髓损伤，采用前路手术可获得满意的临床效果。前路手术恢复了正常颈椎结构，促进了功能恢复，取得了良好的远期疗效。
BACKGROUND: Lower cervical fracture-dislocations frequently occur with spinal cord injuries. There is no clear consensus on best treatment option. Anterior approach surgery with direct decompression and reduction has become widely accepted. We assessed clinical outcomes of anterior approach surgery in a retrospective cohort study.METHODS: From January 2001 to January 2011, 312 patients with lower cervical spine fracture-dislocation with spinal cord injuries who were treated by the anterior approach were retrospectively analyzed. Of 312 patients, 218 (70%; 121 men and 97 women) met inclusion criteria. Clinical efficacy was evaluated using Odom's criteria and statistical analysis based on Cobb angle of kyphosis and Neck Disability Index and Japanese Orthopedic Association scores. Neurofunctional recovery of patients was assessed by the American Spinal Injury Association system.RESULTS: Average follow-up was 8.9 +/- 2.9 years (range, 5-15 years). Kyphosis angle and Neck Disability Index and Japanese Orthopaedic Association scores were significantly changed from preoperative values of 10.6 degrees +/- 8.9 degrees and 39.7 +/- 4.3 and 7.6 +/- 2.4 to last follow-up values of -5.2 degrees +/- 8.6 degrees and 10.8 +/- 4.6 and 15.6 +/- 1.2 (P < 0.05). Of patients, 197 (90.4%) had good to excellent outcomes, 14 (6.4%) had satisfactory outcomes, and 7 (3.2%) had poor outcomes. Varying degrees of neurologic function recovery were shown by 143 of the original 218 patients (65.6%) and 140 of 191 patients with incomplete paralysis (73.3%).CONCLUSIONS: For lower cervical fracture-dislocation with spinal cord injuries, satisfactory clinical outcomes can be obtained with an anterior approach. The anterior approach restored normal cervical spine structure and promoted functional recovery to achieve a good long-term curative effect.