One-stage Operation In Combination With Posterior Transpedicular Screws And Posterior Lateral Mass Screws And Anterior Titanium Plate Fixation Approach To Treat Severe Fracture And Dislocation Of The Low Lower Cervical Spine

Objective:The lower cervical spine injuries means the C3～7’s fracture and dislocation because all kinds forms of violence, including Buckling, Stretch, rotation Etc. The lower cervical spine injuries is the most common sites of cervical spine injury. Usually associated with varying degrees of acute spinal cord injury (SCI), Clinical especially C5～7hyperextension injury is most common. Severe cervical fracture and dislocation result in varying degrees of spinal cord injury (SCI). Critically ill patient’s vertebral displacement is serious, There is often a two-way front and rear side of oppression, The three-pillar structure of the cervical was destroyed, Cervical rear of the ligament rupture, loss of stability, Simple anterior or posterior surgery can not achieve the decompression and restore the stability of the integrated effect of, Therefore, the use of posterior, anterior joint surgery treatment, Variety of surgical procedures, Practical application conditions, no uniform standard, Common surgical approach in varying degrees of risk of complications during and after, For severe low cervical fracture and dislocation,We use a relatively new one posterior lateral mass screw and pedicle screw joint anterior interbody fusion surgery treatment. In this paper, the preoperative, intraoperative, postoperative observation in order to investigate the clinical efficacy. This article is to investigate the clinical efficacy of preoperative, intraoperative, and postoperative observation.Methods:Collect in Hebei Hospital University Third Hospital, spine orthopedic(2009.4-2011.7)received surgical treatment for low cervical spine(C5～7) fracture and dislocation of patient information. According to the diagnostic criteria for severe lower cervical spine fracture and dislocation, Cervical anterior and posterior structures both have been destroyed, Dislocation in Ⅱ°above, Stability score greater than8into the case,10cases C5-6dislocation,12cases C6-7dislocation. Preoperative Frankel grade:A grade3cases, grade B, nine cases, six cases of class C, D in four cases Were followed up for4months to27months, an average of16months Application Frankel classification and Sunnybrook score evaluation of recovery of neurological function. through the displacement distance and Cobb angle to the level of the injury phase to valuation reset situation, To the the Brantigan method to observe the situation and fusion.Results:Imaging observations indicate that:All patients on admission underwent cervical spine X-ray, CT and MRI, Mainly to the normal cervical sequence abnormalities, Physiological curvature of the destruction, disc space narrowing, vertebral height loss, spinous process, lamina fracture. Degree of dislocation of more than Ⅱ°. MRI showed T2-weighted image shows the spinal cord signal abnormalities of T1, T1, T2signal change, Patients with severe spinal cord interruption performance. After surgery,22patients were followed up, Intervertebral height and cervical lordosis recovered well, All bone grafting are the fusion. Fracture without internal fixation, loosening and prolapse, No nerves, blood vessels, esophagus damage and other complications. In addition to the three cases Frankel A postoperative spinal cord function, no significant recovery, Frankel grade no changes, The remaining cases after surgery, an average increase of1.2. Sunnybrook score from before surgery (2.87±1.67) increased to12month follow-up after surgery (6.64±2.15). Before surgery Sunnybrook score after surgery was statistically significant (t=10.05, P<0.01). The damage phase of the average displacement from an average of3.2cm before surgery was reduced to0.4cm. Cobb angle of9°before surgery reduced to1.4°after surgery.3months after surgery21patients with E-level fusion(Bone bridge formation, Mature bone trabeculae, More dense bone tissue imaging),1patients with D-level fusion (Suspicious fusion, After the approximate integration of the regional imaging performance and surgical),12month follow-up of22 patients have reached the E-level fusion.Intervertebral height and cervical lordosis good recovery, all bone graft were integrated.No internal fixation fracture, loose and prolapse, nerves, blood vessels, esophagus damage and other complications.Conclusion:Cervical fracture and dislocation of acute cervical spine injury is a result of violent trauma,The three-pillar structure of the cervical spine were varying degrees of damage, Normal cervical changes in the structure, Vertebrae, vertebral fractures, Ligament folds compress the spinal cord, With various degree of spinal cord and nerve root injury, Result in patients with neurological symptoms, incomplete paralysis of limbs, varying degrees of paralysis, and even the whole. Patients with catastrophic consequences. Timely surgical decompression and cervical internal fixation to stabilize the spine, Restore the normal sequence of the cervical spine.Provide good conditions for the recovery of neurological function. Serious cervical fracture and dislocation of early surgical decompression and fixation to restore the treatment of cervical sequence has been widely recognized, But the question of which surgical approach in line there is considerable controversy Controversy is mainly select Simplex anterior surgery or just posterior surgery or combined anterior. Cervical fracture and dislocation in patients with severe low, there is often the front and rear structures were destroyed, The spinal cord is easy to form a two-way oppression, Simple anterior or the posterior can not guarantee complete decompression and reconstruction of stability of cervical spine after surgery. One-stage Operation in Combination with Posterior Transpedicular Screws and Posterior Lateral Mass Screws and Anterior Titanium Plate Fixation Approach available to complete decompression, satisfactory reduction and immediate reconstruction of the three-column stability, Has the characteristics of the surgery is safe, reliable fixation and bone graft fusion rate, It Is the ideal surgical treatment of severe low cervical fracture and dislocation. In this study, selected a limited number of cases, follow-up time is shorter, the long-term effect remains to be seen Need to further increase the number of cases and the long-term follow-up, And long-term efficacy compared with other surgical methods for further evaluation of its long-term efficacy.