目的 观察颈后路侧块螺钉固定治疗下颈椎骨折脱位的远期效果.方法 选取2014年12月～2016年12月解放军第九八医院收治的90例下颈椎骨折脱位患者,按照不同的手术类型分为对照组与观察组,每组各45例.对照组给予颈前路钢板固定治疗,观察组给予颈后路侧块螺钉固定治疗.对比两组手术时间、术中出血量、骨折愈合时间、术后并发症发生率、随访12个月脊髓功能评分及神经功能分级.结果 观察组与对照组相比手术时间短,术中出血量少,差异有统计学意义(P＜0.05).两组骨折愈合时间及术后并发症发生率差异无统计学意义(P＞0.05).两组治疗后与治疗前相比JOA评分均升高,差异有统计学意义(P＜0.05).两组治疗后第12个月JOA评分差异无统计学意义(P＞0.05).两组治疗后与治疗前相比神经功能ASIA分级明显改善,观察组治疗后改善更显著,差异有统计学意义(P＜0.05).结论 颈后路侧块螺钉固定治疗下颈椎骨折脱位的远期效果优于颈前路钢板固定治疗,但在实施期间需严格遵守临床适应证,从而确保较好的临床效果.%Objective To observe the long-term efficacy of neck roadside block screw fixation in the treatment of lower cervical vertebrae fracture dislocation.Methods 90 cases of patients with lower cervical vertebrae fracture dislocation treated in the 98th Hospital of PLA from December 2014 to December 2016 were selected.All the patients were divided into the control group and the observation group according to the different operation types,45 cases in each group.Patients in the control group were given anterior cervical plate fixation treatment,while patients in the observation group were given neck roadside block screw fixation.The operation time,intraoperative blood loss,fracture healing time,postoperative complications,the spinal cord function score and neural function grading after 12 months of followup were compared between the two groups.Results Compared with the control group,the observation group had shorter operation time,less intraoperative blood loss,with statistically significant differences (P ＜ 0.05).There were no significant differences in fracture healing time and postoperative complication rate between the two groups (P ＞ 0.05).The JOA scores of the two groups increased after treatment compared with before treatment,with statistically significant differences (P ＜ 0.05).12 months after treatment JOA score of the two groups had no significant difference (P ＞ 0.05).The neurologic ASIA grading of two groups after treatment dramatically improve compared with before treatment,and the improvement of observation group were more remarkable after treatment than the control group after treatment,with statistically significant difference (P ＜ 0.05).Conclusion The long-term efficacy of neck roadside block screw fixation in the treatment of lower cervical vertebrae fracture dislocation is better than the anterior cervical plate fixation,but it need strictly comply with the clinical indications to ensure the satisfied clinical efficacy.
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