One-stage posterior reduction single nail and rod fixation combined with the anterior operation for lower cervical fracture-dislocation combined with unilateral locked facet_West China Medical Journal

Authors：

LI Wen , YANG Han , WANG Song , WANG Qing ,  KANG Jianping

Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

KANG Jianping, Email: kjp8@163.com

Keywords：

Cervical vertebra; Fracture-dislocation; Single nail and rod fixation; Unilateral locked facet

DOI：

10.7507/1002-0179.201808042

Video：

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ObjectiveTo investigate the effect of one-stage posterior reduction single nail and rod fixation combined with the anterior operation on lower cervical fracture-dislocation combined with unilateral locked facet.MethodsA retrospective analysis of 28 patients with lower cervical fracture-dislocation combined with unilateral locked facet who underwent one-stage posterior-anterior approach surgery between June 2012 and March 2017 were conducted. The Cobb angle, vertebral body horizontal displacement, height of intervertebral space, recovery of nerve function and operative complications were observed before and after operation.ResultsAll patients were followed up for 12-24 months, with an average of (18.9±4.7) months. All the patients received good reposition after operation without complications such as large blood vessels, trachea, esophagus, spinal dura mater injury and so on. The incisions healed well in all patients. Postoperative complications: postoperative hoarseness and dysphagia occured in 3 cases, pharynx and larynx pain in 8 cases, pulmonary infection in 1 case, and hyponatremia in 2 cases; all patients recovered after the related symptomatic treatment. Postoperative X-ray showed that all the patients were completely corrected without residual small joint semi dislocation and kyphosis. No spinal cord or nerve injury aggravators occurred after surgery. The neurological function of all patients was improved to different degrees 12 months after operation. American Spinal Cord Injury Association (ASIA) classification showed that, of the 6 cases classified as type B preoperatively, 4 cases turned into type C and 2 cases into type D postoperatively; of the 13 cases classified as type C preoperatively, 10 cases turned into type D and 3 into type E postoperatively; and all the 8 cases classified as type D preoperatively turned into type E postoperatively. The ASIA scores increased by 1-2 levels compared with those before operation (P<0.05). The height of cervical intervertebral space, physiological curvature and cervical stability of all patients were well maintained 7 days and 12 months after operation, which were significantly improved compared with those before operation (P<0.05). There was no significant difference between the two follow-up visits at 7 days and 12 months after operation. The Japanese Orthopaedic Association score at 12 months after operation (14.6±2.3) was significantly better than that before operation (6.8±2.6), and the average improvement rate was (79.6±18.8)% (P<0.05). No complications such as screw loosening, fracture or displacement occurred during follow-up.ConclusionOne-stage posterior reduction single nail and rod fixation combined with the anterior operation is safe and effective for the treatment of lower cervical fracture-dislocation combined with unilateral locked facet.

Citation： LI Wen, YANG Han, WANG Song, WANG Qing, KANG Jianping. One-stage posterior reduction single nail and rod fixation combined with the anterior operation for lower cervical fracture-dislocation combined with unilateral locked facet. West China Medical Journal, 2018, 33(9): 1085-1089. doi: 10.7507/1002-0179.201808042 Copy

1.	Wilson JR, Vaccaro A, Harrop JS, et al. The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study. Spine (Phila Pa 1976), 2013, 38(2): 97-103.
2.	沈頌超, 任戈亮, 張結合, 等. Halo-Vest 支架治療單純頸椎骨折脫位的臨床療效分析. 中國骨與關節損傷雜志, 2013, 28(11): 1043-1044.
3.	嚴峻, 衡中華, 冒四平, 等. 頸椎脫位手術入路及術式的前瞻性選擇. 中國骨與關節損傷雜志, 2013, 28(9): 840-841.
4.	Du W, Wang C, Tan J, et al. Management of subaxial cervical facet dislocation through anterior approach monitored by spinal cord evoked potential. Spine (Phila Pa 1976), 2014, 39(1): 48-52.
5.	陳孝平, 汪建平. 外科學. 8 版. 人民衛生出版社, 2013: 132.
6.	美國脊髓損傷協會, 國際脊髓損傷學會. 脊髓損傷神經學分類國際標準 (2011 年修訂). 李建軍, 王方永, 譯. 中國康復理論與實踐, 2011, 17(10): 963-972.
7.	井上駿一, 片岡治. 腰腿疾患治療成績制定基準. 日整會志, 1984, 58: 925.
8.	陳科, 靳安民, 陳仲, 等. 大重量顱骨牽引結合兩種手術治療下頸椎骨折脫位伴關節突交鎖. 中國矯形外科雜志, 2011, 19(24): 2041-2044.
9.	Eranki V, Koul K, Mendz G, et al. Traumatic facet joint dislocation in Western Australia. Eur Spine J, 2016, 25(4): 1109-1116.
10.	施鳳超, 張寧, 蔡衛華. 前后聯合入路治療下頸椎關節突交鎖合并脊髓損傷. 江蘇醫藥, 2010, 36(11): 1287-1289.
11.	曹鵬, 梁裕, 龔耀成, 等. 下頸椎骨折脫位伴關節突交鎖的治療策略選擇. 中國矯形外科雜志, 2007, 15(2): 81-84.
12.	姚關鋒, 王新家, 王偉東, 等. Halo-vest 支架復位聯合前路減壓內固定治療下頸椎骨折脫位. 中華創傷雜志, 2015, 31(8): 695-698.
13.	Yu ZS, Yue JJ, Wei F, et al. Treatment of cervical dislocation with locked facets. Chin Med J(Engl), 2007, 120(3): 216-218.
14.	Scherping SC, Lauerman WC. Facet dislocations of the cervical spine. Semin Spine Surg, 2001, 13(1): 2-10.
15.	劉勇, 卲川強, 陳長春, 等. 不同術式治療下頸椎骨折脫位伴脊髓損傷. 實用骨科雜志, 2015, 21(6): 481-485.
16.	郭琰, 周方, 田耘, 等. 下頸椎骨折脫位術式選擇及療效分析. 中華創傷雜志, 2015, 31(3): 232-235.
17.	王雷, 柳超, 田紀偉. 下頸椎骨折脫位的治療術式選擇. 中國脊柱脊髓雜志, 2013, 23(7): 610-616.
18.	張偉, 楊博貴, 劉愛文. 經前后路聯合椎弓根釘內固定治療 67 例頸椎骨折脫位的療效評價. 中國骨與關節損傷雜志, 2014, 29(7): 645-647.
19.	Beatson T. Fractures and dislocations of the cervical spine. J Bone Joint Surg Br, 1963, 45(1): 238-243.
20.	Braakman R, Vinken PJ. Unilateral facet interlocking in the lower cervical spine. J Bone Joint Surg Br, 1967, 49(2): 249-257.
21.	陳建, 楊再超, 趙存塞, 等. 單側椎弓根螺釘固定治療難復性單側下頸椎關節突絞鎖. 寧夏醫科大學學報, 2015, 37(11): 1349-1351, 1374.
22.	邵高海, 焦春燕, 余雨, 等. 單側椎弓根螺釘置入并椎間融合對鄰近椎間盤節段退變的影響. 中國組織工程研究與臨床康復, 2011, 15(13): 2317-2321.
23.	董健文, 邱奕雁, 趙衛東, 等. 單側椎弓根釘棒固定單節段腰椎及其鄰近節段生物力學研究. 中國臨床解剖學雜志, 2010, 28(1): 85-89.
24.	Fehlings MG, Perrin RG. The timing of surgical intervention in the treatment of spinal cord injury: a systematic review of recent clinical evidence. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S28-S35; discussion S36.
25.	Vaccaro AR, Daugherty RJ, Sheehan TP, et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine (Phila Pa 1976), 1997, 22(22): 2609-2613.

1. Wilson JR, Vaccaro A, Harrop JS, et al. The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study. Spine (Phila Pa 1976), 2013, 38(2): 97-103.
2. 沈頌超, 任戈亮, 張結合, 等. Halo-Vest 支架治療單純頸椎骨折脫位的臨床療效分析. 中國骨與關節損傷雜志, 2013, 28(11): 1043-1044.
3. 嚴峻, 衡中華, 冒四平, 等. 頸椎脫位手術入路及術式的前瞻性選擇. 中國骨與關節損傷雜志, 2013, 28(9): 840-841.
4. Du W, Wang C, Tan J, et al. Management of subaxial cervical facet dislocation through anterior approach monitored by spinal cord evoked potential. Spine (Phila Pa 1976), 2014, 39(1): 48-52.
5. 陳孝平, 汪建平. 外科學. 8 版. 人民衛生出版社, 2013: 132.
6. 美國脊髓損傷協會, 國際脊髓損傷學會. 脊髓損傷神經學分類國際標準 (2011 年修訂). 李建軍, 王方永, 譯. 中國康復理論與實踐, 2011, 17(10): 963-972.
7. 井上駿一, 片岡治. 腰腿疾患治療成績制定基準. 日整會志, 1984, 58: 925.
8. 陳科, 靳安民, 陳仲, 等. 大重量顱骨牽引結合兩種手術治療下頸椎骨折脫位伴關節突交鎖. 中國矯形外科雜志, 2011, 19(24): 2041-2044.
9. Eranki V, Koul K, Mendz G, et al. Traumatic facet joint dislocation in Western Australia. Eur Spine J, 2016, 25(4): 1109-1116.
10. 施鳳超, 張寧, 蔡衛華. 前后聯合入路治療下頸椎關節突交鎖合并脊髓損傷. 江蘇醫藥, 2010, 36(11): 1287-1289.
11. 曹鵬, 梁裕, 龔耀成, 等. 下頸椎骨折脫位伴關節突交鎖的治療策略選擇. 中國矯形外科雜志, 2007, 15(2): 81-84.
12. 姚關鋒, 王新家, 王偉東, 等. Halo-vest 支架復位聯合前路減壓內固定治療下頸椎骨折脫位. 中華創傷雜志, 2015, 31(8): 695-698.
13. Yu ZS, Yue JJ, Wei F, et al. Treatment of cervical dislocation with locked facets. Chin Med J(Engl), 2007, 120(3): 216-218.
14. Scherping SC, Lauerman WC. Facet dislocations of the cervical spine. Semin Spine Surg, 2001, 13(1): 2-10.
15. 劉勇, 卲川強, 陳長春, 等. 不同術式治療下頸椎骨折脫位伴脊髓損傷. 實用骨科雜志, 2015, 21(6): 481-485.
16. 郭琰, 周方, 田耘, 等. 下頸椎骨折脫位術式選擇及療效分析. 中華創傷雜志, 2015, 31(3): 232-235.
17. 王雷, 柳超, 田紀偉. 下頸椎骨折脫位的治療術式選擇. 中國脊柱脊髓雜志, 2013, 23(7): 610-616.
18. 張偉, 楊博貴, 劉愛文. 經前后路聯合椎弓根釘內固定治療 67 例頸椎骨折脫位的療效評價. 中國骨與關節損傷雜志, 2014, 29(7): 645-647.
19. Beatson T. Fractures and dislocations of the cervical spine. J Bone Joint Surg Br, 1963, 45(1): 238-243.
20. Braakman R, Vinken PJ. Unilateral facet interlocking in the lower cervical spine. J Bone Joint Surg Br, 1967, 49(2): 249-257.
21. 陳建, 楊再超, 趙存塞, 等. 單側椎弓根螺釘固定治療難復性單側下頸椎關節突絞鎖. 寧夏醫科大學學報, 2015, 37(11): 1349-1351, 1374.
22. 邵高海, 焦春燕, 余雨, 等. 單側椎弓根螺釘置入并椎間融合對鄰近椎間盤節段退變的影響. 中國組織工程研究與臨床康復, 2011, 15(13): 2317-2321.
23. 董健文, 邱奕雁, 趙衛東, 等. 單側椎弓根釘棒固定單節段腰椎及其鄰近節段生物力學研究. 中國臨床解剖學雜志, 2010, 28(1): 85-89.
24. Fehlings MG, Perrin RG. The timing of surgical intervention in the treatment of spinal cord injury: a systematic review of recent clinical evidence. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S28-S35; discussion S36.
25. Vaccaro AR, Daugherty RJ, Sheehan TP, et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine (Phila Pa 1976), 1997, 22(22): 2609-2613.

West China Medical Journal

One-stage posterior reduction single nail and rod fixation combined with the anterior operation for lower cervical fracture-dislocation combined with unilateral locked facet

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