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[Treatment of lower cervical fracture dislocation by titanium screw-plate internal fixation on cervical lateral mass].

AbstractOBJECTIVE:
To evaluate surgical results of the titanium screw-plate internal fixation in treatment of the lower cervical fracture dislocation.
METHODS:
From September 2001 to March 2006, 31 patients (24 males, 7 females; age range, 20-63 years) with the lower cervical fracture dislocation were treated in our department. The injuries were caused by a road accident in 25 patients, a high crash in 4, and a heavy object crash in 2. The fracture dislocation occurred in the following cervical segments: C3 (1 patient), C1 (5 patients), C5 (12 patients), C6 (10 patients), and C7 (3 patients). The disease course ranged from 1 to 23 days. The associated spinal nerve root injury occurred in 29 patients. The Frankle scaling revealed that 14 patients were at Grade A, 3 at Grade B, 7 at Grade C, 3 at Grade D, and 2 at Grade E (associated nerve root injury with hand and shoulder numbness). The 29 patients underwent the spinal cord decompression, the grafting fusion of the small joints, and the lateral mass titanium screw-plate internal fixation; 2 patients without nerve injury underwent only the grafting fusion of the small joints and the lateral mass titanium screw-plate internal fixation. The bone fusion, cervical vertebra movement, and internal fixation condition were observed by the X-ray examinations postoperatively. The nerve function recovery was evaluated by the Frankle scaling system.
RESULTS:
The followed-up in all the patients for 6 months to 4 years revealed that the small joint fusion time was 3-6 months, with an average of 3. 6 months. The cervical X-ray films showed that there was no instability or fracture looseness of the internal fixation at 6 months. Among the 29 patients with the spinal nerve root injury, 14 were at Grade A preoperatively but 13 were improved at Grade B and 1 at Grade C postoperatively; 3 were at Grade B preoperatively but 2 were improved at Grade C and 1 at Grade D postoperatively; 7 were at Grade C preoperatively but 3 were improved at Grade D and 4 at Grade E postoperatively; 3 at Grade D preoperatively but all the 3 were improved at Grade E postoperatively; 2 were at Grade E preoperatively and remained unchanged postoperatively. In the 2 patients with only the nerve root injury, numbness disappeared soon after operation.
CONCLUSION:
This posterior approach has two advantages: the mobility range of the cervical vertebra can preserved to the greatest extent because of the short segment fixation; the better stability can obtained because of the titanium screw-plate internal fixation on the cervical joint-column to prevent the hyperextension and hyperflexion. Therefore, the titanium screw-plate internal fixation on the cervical lateral mass is an effective treatment of the lower cervical fracture dislocation.
AuthorsXin Zhang, Mushun He, Zhankui Zhang
JournalZhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery (Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi) Vol. 21 Issue 4 Pg. 374-7 (Apr 2007) ISSN: 1002-1892 [Print] China
PMID17546882 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Titanium
Topics
  • Adult
  • Bone Screws
  • Bone Transplantation (methods)
  • Cervical Vertebrae (diagnostic imaging, injuries, surgery)
  • Decompression, Surgical
  • Female
  • Follow-Up Studies
  • Fracture Fixation, Internal (methods)
  • Humans
  • Joint Dislocations (surgery)
  • Male
  • Middle Aged
  • Radiography
  • Spinal Fractures (diagnostic imaging, surgery)
  • Spinal Fusion
  • Spinal Nerve Roots (injuries)
  • Titanium
  • Treatment Outcome

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