The Surgical Option And Curative Effect Of Lower Cervical Vertebrae Fracture And Dislocation Combined With Articular Process Interlocking

Objective:By analyzing the clinical cases of fracture and dislocation of lower cervical vertebrae combined with articular process interlocking,the choice and curative effect of three different surgical methods were compared and studied..Methods:From September 2015 to September 2017,38 patients with fracture and dislocation of lower cervical vertebrae associated with articular process interlocking in our department were retrospectively analyzed if the patients met the screening criteria and the data were complete.Among them,26 cases were operated by anterior approach,5 cases were operated by posterior approach and 7 cases were operated by combined anterior and posterior approach.There were 5 cases with cervical 3-4 vertebrae,12 cases with cervical 4-5 vertebrae,18 cases with cervical 5-6 vertebrae and 3 cases with cervical 6-7 vertebrae.The operative time and intraoperative blood loss were analyzed and compared among the three groups.Meanwhile,the preoperative,postoperative,intervertebral space height and Cobb angle of the patients from the three groups wereanalyzed and compared.Cervical Spine JOA scoring Standard(Schedule1)and Frankel classification of spinal cord injury(Schedule 2)were applied to evaluate the recovery of postoperative neurological function.Results:All the 38 patients had successful operations without trachea,esophagus leakage and large vascular injury,and the postoperative neurological symptoms were not aggravated.The follow-up time was6-24 months,with an average of 14.2 months,and the follow-up data were collected completely.Through the analysis results of the three surgical methods,all the patients with fracture and dislocation of lower cervical vertebrae associated with articular process interlocking recovered to normal.The postoperative cervical intervertebral height and Cobb angle of cervical vertebrae were significantly improved compared with those before operation.The operative time of the anterior approach group was significantly lower than those of the posterior approach group and the combined anterior and posterior approach group,and the difference was statistically significant(p<0.05).The amount of intraoperative blood loss was significantly reduced,and the difference was statistically significant(p<0.05).The intervertebral space height and Cobb angle of cervical vertebrae were significantly improved compared with those before operation,and the difference was statistically significant(p<0.05).Recovery of neural function was displayed as followed: the JOA scores ofall the patients were improved in different degrees after 6 months compared with those before operation,and the difference was statistically significant(p<0.05).There was no significant difference in the improvement rate among the three groups(p>0.05).The Frankel classification of all the patients was improved by 1-2 grade on average in6 months after surgery.Four patients with no significant neurological recovery were suffered spinal cord injury,while 34 patients achieved significant recovery of neurological function.Conclusion:For the patients with fracture and dislocation of lower cervical vertebrae combined with articular process interlocking,the normal sequence of cervical vertebrae could be restored by the three operative approaches,and postoperative cervical intervertebral height,Cobb angle and neurological function were improved.The operation time and the amount of intraoperative blood loss in the anterior approach group were significantly less than those in the posterior approach group and the combined anterior and posterior approach group.For the choice of surgical methods,it should be given priority to the simple anterior approach,and the degree of posterior structural injury,stability,the location and extent of spinal cord compression,and individual situation should be considered with the posterior adjuvant therapy.