| Purpose of review:The fracture and dislocation of the lowercervical spine (FDLCS) is very common in clinic, with thedevelopment of modernization the injure of this kind caused by trafficaccidents increase day by day. Being accompanied with the spinalcord injure (SCI), the FDLCS is very dangerous. Reducing early torelief the oppression of the spinal cord is the key point of the treatmentand the method of reduction is much important. Objective: To summarize the experiences and the recentadvances in reduction of the fracture and dislocation of the lowercervical spine and analyze the advantages and disadvantages of thedifferent methods of the reduction and discuss the best method ofreduction to the different kind of FDLCS. Object: 32 FDLCS managed between 2001~2005 at ourdepartment were involved, 24 male and 8 female,the average age was41(27-61). The mechanisms of injure to the FDLCS included 12traffic accidents injure , 10 fall injure , 8 crash injure and 2 sportsinjure. The location of the dislocation: 1 case was C4, 22 cases wereC5 and 9 cases were C6. According to the AO standard, 12 cases wereB3.1, 3 cases were B3.2, 8 cases were C2.1, 3 cases were C3.1, 6cases were C3.2. According to the Frankel standard of spinal cordfunction, 12 cases were A, 2 cases were B, 7 cases were C, 9 caseswere D and 2 casess were E. Method: 24 cases underwent closedreduction using Grutchfield tongs traction and 8 cases using Glissontraction. The cases obtained the reduction and all the B3.1 cases failedreduction underwent the anterior approach;the cases failed reductionand be established by MRI that there was anterior oppression on thespinal cord underwent combined anterior-posterior approach;the casesfailed reduction and be established by MRI that has no disc herniationunderwent posterior approach , as well as the cases of which spinalcord destroyed completely.Result: 24 cases underwent closed skull reduction using Grutchtongs traction, 4 cases of B3.1 wholly obtained reduction, 3 cases ofB3.2 wholly failed reduction, among 8 cases of C2.1 there were 2cases obtained reduction, among 3 cases of C3.1 there were 1 caseobtained reduction, among 6 cases of C3.2 there were 4 cases obtainedreduction. All the cases followed up 8~24 months, the average is 12months. 32 cases obtained instantly stability of cervical spine afteroperation, resumpt the sequence and curvature of the cervical spine, aswell as vertebra altitude. According to the Frankel standard of spinalcord function, 12 cases of A had no recovery, the rest had recovery of1~2 stage.Conclusion: 1. To resumpt the normo-sequence of cervical spine,decompress thoroughly, resumpt vertebra altitude and curvature ofcervical spine and obtained instantly stability of cervical spine is thebasic principle of the treatment of FDLCS. Reducing early to relief theoppression of the spinal cord is the key point of the treatment and themethod of reduction is much important. 2. Different methods ofreduction should be taken according to the different kinds of FDLCS.â‘ closed skull reduction using Grutch tongs traction:FDLCS of B3.1should take the skull traction as the first choice;FDLCS of C2.1 andC3.2 could undergo the Grutch tongs traction, if failed in short-term,operation should be taken immediately;FDLCS of B3.2 andC3.1 should take operation as the first choice. â‘¡ Operation: The casesobtained reduction and all the B3.1 cases failed reduction shouldundergo the anterior approach;the cases failed reduction and beestablished by MRI that there was anterior oppression on the spinecord should undergo combined anterior-posterior approach;the casesfailed reduction and be established by MRI that has no disc herniationshould undergo posterior approach, as well as the cases of whichspinal cord destroyed completely.
|
PDF Full Text Request