| Background:Lower cervical dislocation is a typical flexion injury,which can occur in any segment between C3 and C7.The most common segment is below C4.C5-6 is the most common segment.This kind of injury is more serious and easy to be combined with irreversible spinal cord injury.The position of the C4 vertebral body corresponds roughly to that of the corresponding cervical segment and belongs to the upper cervical spinal cord(C1~C4).Upper cervical spinal cord injury can cause respiratory paralysis,dyspnea or mechanical obstruction of the respiratory tract as it affects the respiratory center,thus endangering life.Spastic paralysis of limbs below the level of injury can occur in survivors.Upper cervical spinal cord injury(SCI)can cause secondary medullary dysfunction,resulting in cardiovascular system and other serious visceral dysfunction,which is highly lethal and disabled.Because there are few survivors of C1~C3 injuries,while C4 injuries may survive if treated correctly and promptly.At present,there are few studies on prognosis and survival of patients with C4 dislocation at home and abroad.Objective:Based on the retrospective analysis of patients with C4 dislocation,the operation time,intraoperative bleeding volume,JOA score,JOA improvement rate and ASIA spinal cord injury grade of patients with different surgical treatment schemes were analyzed statistically.The factors that may affect prognosis such as sex,age,smoking,operation mode,dislocation degree and operation interval time after injury were all analyzed to provide reference for the treatment of C4 dislocation with spinal cord injury.Materials and methods:The subjects were 41 patients with C4 dislocation who received complete medical records from October 2009 to December 2017 in orthopaedics department.All patients received surgical treatment and could cooperate with follow-up.The average follow-up time was 41.77±5.22 months.There were 33 males and 8 females.The age ranged from 21 to 79 years,with an average of 47.63±15.62 years.Among them,30 are Han,5 are Korean,4 are Manchu and 2 are Mongolian.Among 41 cases of C4 dislocation,29 cases were first degree dislocation,7 cases were second degree dislocation,4 cases were third degree dislocation and 1 case was fourth degree dislocation.There were 8 cases of unilateral dislocation of articular process and 33 cases of bilateral dislocation of articular process.All patients received ASIA spinal cord injury grading and JOA score after admission,including 6 cases of grade A,13 cases of grade B,13 cases of grade C,9 cases of grade D and 0 cases of grade E.According to the operation methods,28 cases were divided into anterior approach group,4 cases into posterior approach group and 9 cases into combined anterior and posterior approach group.IBM SPSS 19.0 was used to collate and analyze the data.If the statistical data conformed to the homogeneity of variance and normal distribution,the mean t test of two independent samples was used.P < 0.05 was the standard with statistical significance.If the variance is not uniform,the approximate t test is used.The JOA score and age of the three groups were tested by independent sample t test before operation(P > 0.05),which showed that there was no significant difference in the JOA score and age of the three groups before operation,and the data of the three groups were comparable.At the same time,the operation time,intraoperative bleeding volume,JOA score before operation and during the last follow-up,JOA improvement rate and ASIA spinal cord injury grade were analyzed at the statistical level.Kaplan-Meier method was used to calculate the survival rate,log-rank method was used to test the difference of univariate survival rate and to compare the distribution of survival curve of each group.Cox regression model was used for multivariate analysis,P < 0.05 was the difference with statistical significance.Results:As of the last follow-up,there were 11 deaths,including 9 males and 2 females.There were significant differences among the three groups in the amount of intraoperative bleeding,and the lowest amount of intraoperative bleeding was in the anterior approach group(78.93±27.16 ml,P < 0.05).In terms of operation time,there was no difference between the anterior approach group and the posterior approach group(t=-2.512,P=0.083>0.05).Compared with the other two groups,the anterior and posterior approach group had longer operation time(207.22±43.53min),and there was significant difference(P<0.05);in terms of JOA score,the JOA score was significantly improved at the last follow-up between the same group(P < 0.05),and there was no significant difference in the improvement rate between different groups(P > 0.05).Cox multivariate regression model was used to analyze the multivariate survival analysis of the relevant prognostic factors with statistical significance.The results showed that non-smoking(P=0.001,OR=0.006)and degree of dislocation(degree I dislocation)(P=0.042,OR=0.04)were independent influencing factors of survival prognosis and relative protective factors(P<0.05,OR<1).Sex,age,operation method and interval time after injury had no significant effect on prognosis and survival(P > 0.05).Conclusions:1.For patients with C4 dislocation and spinal cord injury,anterior approach has a better advantage if conditions permit and can achieve the desired therapeutic effect,considering the operation time and intraoperative bleeding volume.2.There is no significant difference in the improvement of neurological function score between the three surgical methods.3.The prognostic survival time of non-smokers and patients with degree I dislocation is significantly better than that of smokers or other people with degree of dislocation.4.Sex,age,surgical method and interval time after injury have no significant effect on prognosis and survival.5.Respiratory complications are the main cause of death.Good respiratory interventions are of great significance to patients.6.Reasonable surgical plan should be formulated according to the actual situation of patients. |
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