Clinical Study Of Skull Traction Combined With Self-made Reduction Tool For Anterior Cervical Surgery In The Treatment Of Lower Cervical Fracture And Dislocation

Background:The lower cervical vertebra,that is,C3-C7,is the site with the largest range of motion of the spine.Cervical trauma accounts for 65% of cervical injuries,of which 6% to 10% of the patients are lower cervical fracture and dislocation.When lower cervical fracture and dislocation combined with articular process interlock,the main clinical manifestations are severe pain in the neck muscle,cervical instability and compression of the spinal cord nerve should be treated as soon as possible,otherwise permanent limb dysfunction may occur,or even life-threatening.At present,the common surgical scheme for patients with single-segment lower cervical fracture and dislocation with articular process interlock is posterior cervical decompression reduction plus anterior cervical decompression and bone graft internal fixation under skull traction,but the operation is complicated,bleeding and trauma are large,and the postoperative recovery is slow.In order to further optimize the surgical operation and improve the surgical effect,the team developed a top pressure reducer and vertebral nail tools,which are easy to operate and can be directly fixed on the dislocated vertebral body,combined with skull traction,prying force and booster force.in line with the biomechanical principle of reverse reduction of joint dislocation,bilateral articular process interlock can be effectively reduced,so as to avoid posterior operation.Objective : To observe the reduction and improvement of nerve function of single segment lower cervical fracture and dislocation complicated with articular process interlock treated by skull traction combined with self-made reduction tool in anterior cervical surgery,and to explore its clinical effect.Methods: Forty-two patients with single segment interlocking dislocation of lower cervical spine treated in our hospital from April 2016 to May 2021 were treated with one-stage anterior cervical decompression and Cage bone graft fusion and internal fixation.Skull traction combined with self-made reduction tools were used during the operation.The patients were followed up for 6 to 12 months,and the American Spinal Cord injury Association(American Spinal Injury Association,ASIA)grade was evaluated before and at the last follow-up.CT,X-ray and MRI were performed before operation,1 week after operation and at the last follow-up to evaluate the changes of Cobb angle,spinal cord nerve decompression and interlocking reduction of articular process.Cervical dysfunction index(neckdisabilityindex,NDI)and visual analogue scale of pain(visualanaloguescale,VAS)were evaluated before operation,1 week after operation and the last follow-up.Results:The operations of 42 patients were completed successfully without rupture of carotid artery,vertebral artery and esophagus,and satisfactory reduction was achieved in all cases,including 39 cases of complete reduction and 3 cases of incomplete reduction.1 case died of respiratory and cardiac arrest due to high spinal cord nerve injury,1 case was complicated with severe pneumonia after operation,and the other 40 patients were followed up for 6 12(7.5 ±0.3)months.Of the 42 patients,2 were in grade A(including 1 death),7 in grade B(including 1 automatic discharge),16 in grade C,13 in grade D and 4 in grade E according to ASIA grade before operation.Except for death and automatic discharge,at the last follow-up,there was no change in 1 case of grade An in the other 40 cases,1 case of grade B in 6 cases,5cases of grade D,7 cases of grade D and 9 cases of grade E in 16 cases of grade C,13 cases of grade D were changed to grade E,and 4 cases of grade E had no change.The Cobb angle of 40 patients at 1 week after operation and at the end of follow-up was larger than that before operation(P < 0.05).At the last follow-up,the Cobb angle was larger than that at 1 week after operation.NDI score and VAS score at 1week after operation and at the last follow-up were lower than those before operation.NDI and VAS scores at the last follow-up were lower than those at 1 week after operation.During the last follow-up,40 patients were examined by cervical X-ray and CT,which showed that the reduction of fracture and dislocation,the position of internal fixation and the recovery of cervical sequence were good,and the cervical MRI examination showed that the spinal cord nerve decompression was sufficient.Conclusion:Skull traction combined with self-made reduction tool was used in anterior cervical surgery to treat single segment lower cervical fracture and dislocation with articular process interlocking,with high reduction success rate,few postoperative complications and obvious improvement of postoperative neurological function.