| Objective: To compare the therapeutic effect of anterior fusion and internal fixation and posterior-anterior fusion and internal fixation under microscope or not use microscope in the treatment of lower cervical spine fracture dislocation. To investigate the advantages of microscope in the operation of lower cervical spine fracture and dislocation.Methods: From January 2007 –January 2015,there were 51 patients with fracture and dislocation of lower cervical spine combined with spinal cord injury. According to whether used microscope in the operation process was divided into two groups. The microscope group was 26 cases.12 cases were treated by anterior fusion and internal fixation,14 cases were treated by posterior-anterior fusion and internal fixation. The group without microscope was 25 cases.13 cases were treated by anterior fusion and internal fixation,12 cases were treated by posterior-anterior fusion and internal fixation. Injured area:C3:8 cases,C4:11 cases, C5:17 cases, C6:10 cases, C7:5 cases; The 51 patients had complete follow-up records,the follow-up time was 13-26 months,the average follow-up 14.2 months. To compare the operation time, blood loss during operation neurological improvement(AISA grades),scores calculated according to JOA of post-operation, postoperative improvement rate of symptoms, Cobb angle post-operation one week and post-operation 12 months of two types of operation with microscope and without microscope, and observe whether there were complications. We did the statistics analysis by SPSS20.0 software. P<0.05 had statistic significance.Results: All cases had no plates and screw fracture and achieved good restoration. At the 12 month follow-up, the bone graft were all fused. Anterior fusion group under microscope was 12 cases: The operation time was 70.4min±7.2min, The blood loss was 113.3ml±15.6m1. Postoperative ASIA grade improved in different degree than preoperative, the JOA scores of preoperative was 7.37±2.35,the JOA scores of postoperative was 13.34±2.15,the post-operation improvement rate was 73.27%±18.79%, the pre-operation Cobb angle was-4.4°±3.2°,the post-operation one week Cobb angle was 6.8°±3.9°,the post-operation 12 months Cobb angle was 6.1°±4.1°.No complication occurred after operation. Posterior-anterior fusion group under microscope was 12 cases, The operation time was 210.6min±13.9min, The blood loss was 226.6ml±37.8ml. Postoperative ASIA grade improved in different degree than preoperative, the JOA scores of pre-operation was 7.19±1.26,the JOA scores of postoperative was 13.38±2.31,the postoperative improvement rate was 73.13%±18.43%,the pre-operation Cobb angle was-5.2°±3.4°,the post-operation one week Cobb angle was 6.8°±3.8°,the post-operation 12 months Cobb angle was 6.7°±3.6°. Infection was 1 cases after operation. Anterior fusion group without microscope was 13 cases. The operation time was 81.2min ± 8.0min, The blood loss was 158.3ml±20.3m1. Post-operation ASIA grade improved in different degree than pre-operation except one case, the JOA scores of pre-operation was 7.52±2.45,the JOA scores of post-operation was 11.97±2.18,the post-operation improvement rate was 62.27%±21.77%, the pre-operation Cobb angle was-4.8°±3.7°,the post-operation one week Cobb angle was6.5°±4.1°,the post-operation 12 months Cobb angle was 6.6°±4.3°. Postoperative voice hoarse was 2 cases, cerebrospinal fluid leakage was 2 cases. Posterior-anterior fusion group without use microscope was 12 cases, The operation time was 230.0min±15.0min, The blood loss was 316.6ml±61.0ml. Postoperative ASIA grade improved in different degree than preoperative except one case, the JOA scores of pre-operation was 7.28±1.26,the JOA scores of post-operation was11.15±2.79,the postoperative improvement rate was 62.13%±20.0%, the pre-operation Cobb angle was-5.5°±3.1°,the post-operation one week Cobb angle was6.2°±3.9°,the post-operation 12 months Cobb angle was 6.1°±3.1°. Anterior neck hematoma was 2 cases. The operation time and blood loss in the anterior and posterior-anterior groups were significantly less than that in without microscope group, the difference was statistically significant(P<0.05). Both the postoperative JOA score and postoperative improvement rate of the anterior and posterior-anterior group were better than that of the without microscope group. the difference was statistically significant(P<0.05). And there were no significant difference in the Cobb angle and bone graft fusion of two groups(P>0.05).Conclusion: The clinical effect of anterior and posterior anterior fusion with microscope in the treatment of lower cervical spine fracture dislocation were better than that without microscope group. Surgical treatment under microscope have the advantages of short operation time, less trauma, less bleeding, high safety, and accurate decompression effect. |
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