EFFECTIVENESS AND SAFETY OF SIMPLY ANTERIOR APPROACH FOR LOWER CERVICAL SPINE FRACTURE DISLOCATION (Allen-Ferguson II OR III TYPE) WITHOUT SPINAL CORD INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHUYanming , YUEErsong , KONGQuanwei

Department of Orthopedics, Henan Meitan General Hospital, Zhengzhou Henan, 450003, P.R.China;

Corresponding?author：

ZHUYanming, Email: zyanming2010@126.com

Keywords：

Cervical spine; Fracture and dislocation; Locked-facet; Spinal cord injury; Anterior approach

DOI：

10.7507/1002-1892.20160290

Video：

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Objective To study the effectiveness and safety of simply anterior approach for lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury. Methods Twenty-five patients with lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury were treated between June 2013 and June 2015. There were 17 males and 8 females with an average age of 41.2 years (range, 31-57 years). Injury was caused by falling from height in 11 cases, by bruise in 5 cases, by crash of heavy object in 6 cases, and by traffic accident in 3 cases. There were 24 cases of fresh fractures and 1 case of old fracture. According to the Frankel grading criteria, 19 cases were rated as grade E and 6 cases as grade D. The injured levels included C_{4, 5} in 5 cases, C_{5, 6} in 14 cases, and C_{6, 7} in 6 cases. Unilateral locked-facet joint was observed in 9 cases, and bilateral locked-facet joint in 16 cases. The operation time, intraoperative blood loss, and surgical complications were recorded; the Odom standard was used to evaluate the effectiveness. The Cobb angle and D-value (the degree of cervical kyphosis or lordosis) were measured on the X-ray film, the bone graft fusion rate was recorded. Results The operation was successfully completed in 25 patients; the operation time was 66 to 115 minutes, the intraoperative blood loss was 80 to 220 mL. The postoperative follow-up time was 12 to 36 months (mean, 19.3 months). Postoperative temporary dysphagia occurred in 1 case, and pain at donor site in 2 cases; there were no complications of spinal cord injury, hematoma, hoarse, and esophageal fistula. The nerve function was improved from preoperative grade D to postoperative grade E at 3 months. The X-ray films showed bone graft fusion; there was no loss of intervertebral height or loosening of internal fixation. At 3 months after operation, the effectiveness was excellent in 18 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 96.0%. The postoperative Cobb angle and the D value were significantly improved when compared with preoperative ones (P < 0.05). Conclusion Simple anterior approach has the advantages of good effectiveness, small trauma, and fast recovery for treating lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury.

Citation： ZHUYanming, YUEErsong, KONGQuanwei. EFFECTIVENESS AND SAFETY OF SIMPLY ANTERIOR APPROACH FOR LOWER CERVICAL SPINE FRACTURE DISLOCATION (Allen-Ferguson II OR III TYPE) WITHOUT SPINAL CORD INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1408-1411. doi: 10.7507/1002-1892.20160290 Copy

1.	陳舉, 張朝春.全麻下顱骨牽引復位配合頸前路減壓融合治療下頸椎骨折脫位伴關節突交鎖.第三軍醫大學學報, 2016, 38(1): 93-96.
2.	Riesenburger RI, Potluri T, Kulkarni N, et al. Unilateral cervical facet dislocation: a biomechanical study of several constructs including unilateral lateral mass fixation supplemented by an interspinous cable. J Neurosurg Spine, 2012, 16(3): 251-256.
3.	李玉偉, 嚴曉云, 王海蛟, 等.頸前路先減壓后復位治療下頸椎脫位臨床觀察.中華醫學雜志, 2015, 95(41): 3384-3386.
4.	劉勇, 張國華, 蘭天亮, 等.治療下頸椎骨折脫位伴脊髓損傷的三種手術方式.中國矯形外科雜志, 2015, 23(16): 1461-1464.
5.	李玉偉, 王海蛟, 周小小, 等.前路復位減壓零切跡椎間融合器內固定治療下頸椎脫位.中國脊柱脊髓雜志, 2015, 25(7): 630-636.
6.	常巍, 王達義, 李兵奎, 等.一期后前路聯合手術治療下頸椎骨折脫位伴關節突絞鎖.實用醫學雜志, 2015, 31(12): 2069-2070.
7.	Liu P, Yang JS, Liu TJ, et al. Complete fracture-dislocation of the lower cervical spine without permanent neurological sequel: the typical imaging changes. Spine J, 2016, 16(3): e197-199.
8.	王建元, 鄧強, 盛偉斌, 等.下頸椎骨折脫位修復方法的選擇:植骨融合及頸椎穩定性分析.中國組織工程研究, 2015, 19(4): 522-530.
9.	駱淵城, 敖傳西, 華賢章, 等.不同手術路徑對下頸椎骨折脫位并脊髓損患者生理功能恢復的影響.中國醫藥導報, 2016, 13(21): 111-114.
10.	溫松江.前后路聯合手術治療頸椎骨折脫位并脊髓損傷的臨床效果觀察.臨床合理用藥, 2016, 9(6A): 149-150.
11.	O'Shaughnessy J, Grenier JM, Stern PJ. A delayed diagnosis of bilateral facet dislocation of the cervicalspine: a case report. J Can Chiropr Assoc, 2014, 58(1): 45-51.
12.	Waschke A, Walter J, Duenisch P, et al. Anterior cervical intercorporal fusion in patients with osteoporotic or tumorous fractures using a cement augmented cervical plate system: first results of a prospective single-center study. J Spinal Disord Tech, 2013, 26(3): E112-117.
13.	張宏其.頸椎骨折與脫位治療的幾點思考.中華創傷雜志, 2014, 30(8): 759-761.
14.	劉紀恩, 曹珺, 勾瑞恩, 等. I期前后路聯合手術治療下頸椎骨折脫位合并頸髓損傷的療效.中華創傷雜志, 2015, 31(12): 1077-1079.
15.	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.
16.	張廣泉, 李琳, 高延征, 等.下頸椎骨折脫位伴關節突絞鎖的治療策略.中華創傷骨科雜志, 2013, 15(9): 810-812.
17.	Ngo LM, Aizawa T, Hoshikawa T, et al. Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine. Eur Spine J, 2012, 21(2): 282-288.

1. 陳舉, 張朝春.全麻下顱骨牽引復位配合頸前路減壓融合治療下頸椎骨折脫位伴關節突交鎖.第三軍醫大學學報, 2016, 38(1): 93-96.
2. Riesenburger RI, Potluri T, Kulkarni N, et al. Unilateral cervical facet dislocation: a biomechanical study of several constructs including unilateral lateral mass fixation supplemented by an interspinous cable. J Neurosurg Spine, 2012, 16(3): 251-256.
3. 李玉偉, 嚴曉云, 王海蛟, 等.頸前路先減壓后復位治療下頸椎脫位臨床觀察.中華醫學雜志, 2015, 95(41): 3384-3386.
4. 劉勇, 張國華, 蘭天亮, 等.治療下頸椎骨折脫位伴脊髓損傷的三種手術方式.中國矯形外科雜志, 2015, 23(16): 1461-1464.
5. 李玉偉, 王海蛟, 周小小, 等.前路復位減壓零切跡椎間融合器內固定治療下頸椎脫位.中國脊柱脊髓雜志, 2015, 25(7): 630-636.
6. 常巍, 王達義, 李兵奎, 等.一期后前路聯合手術治療下頸椎骨折脫位伴關節突絞鎖.實用醫學雜志, 2015, 31(12): 2069-2070.
7. Liu P, Yang JS, Liu TJ, et al. Complete fracture-dislocation of the lower cervical spine without permanent neurological sequel: the typical imaging changes. Spine J, 2016, 16(3): e197-199.
8. 王建元, 鄧強, 盛偉斌, 等.下頸椎骨折脫位修復方法的選擇:植骨融合及頸椎穩定性分析.中國組織工程研究, 2015, 19(4): 522-530.
9. 駱淵城, 敖傳西, 華賢章, 等.不同手術路徑對下頸椎骨折脫位并脊髓損患者生理功能恢復的影響.中國醫藥導報, 2016, 13(21): 111-114.
10. 溫松江.前后路聯合手術治療頸椎骨折脫位并脊髓損傷的臨床效果觀察.臨床合理用藥, 2016, 9(6A): 149-150.
11. O'Shaughnessy J, Grenier JM, Stern PJ. A delayed diagnosis of bilateral facet dislocation of the cervicalspine: a case report. J Can Chiropr Assoc, 2014, 58(1): 45-51.
12. Waschke A, Walter J, Duenisch P, et al. Anterior cervical intercorporal fusion in patients with osteoporotic or tumorous fractures using a cement augmented cervical plate system: first results of a prospective single-center study. J Spinal Disord Tech, 2013, 26(3): E112-117.
13. 張宏其.頸椎骨折與脫位治療的幾點思考.中華創傷雜志, 2014, 30(8): 759-761.
14. 劉紀恩, 曹珺, 勾瑞恩, 等. I期前后路聯合手術治療下頸椎骨折脫位合并頸髓損傷的療效.中華創傷雜志, 2015, 31(12): 1077-1079.
15. 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.
16. 張廣泉, 李琳, 高延征, 等.下頸椎骨折脫位伴關節突絞鎖的治療策略.中華創傷骨科雜志, 2013, 15(9): 810-812.
17. Ngo LM, Aizawa T, Hoshikawa T, et al. Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine. Eur Spine J, 2012, 21(2): 282-288.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS AND SAFETY OF SIMPLY ANTERIOR APPROACH FOR LOWER CERVICAL SPINE FRACTURE DISLOCATION (Allen-Ferguson II OR III TYPE) WITHOUT SPINAL CORD INJURY

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