颈椎弓根螺钉置钉并发症原因分析及预防  

Analyze retrospectively the causes of operative complications and management of cervical pedicle screw placement

作　　者：胡勇[1] 杨述华[2] 谢辉[1] 徐荣明[1] 校佰平[1] 马维虎[1] 周雷杰[1] 

机构地区：[1]宁波市第六医院脊柱外科,浙江宁波315040 [2]华中科技大学同济医学院附属协和医院骨科

出　　处：《中国骨伤》2006年第11期645-647,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的：回顾性分析颈椎弓根螺钉置钉术中并发症原因及对策。方法：颈椎骨折脱位患者600例采用颈椎弓根螺钉内固定技术治疗，发生置钉并发症36例，男26例，女10例；年龄26～68岁，平均38．9岁。按Frankel分级：11例为完全性颈髓损伤；25例为不完全性颈髓损伤。结果：在发生置钉并发症36例中共置入椎弓根螺钉204枚，有70枚螺钉方向偏差，其中20枚螺钉初次置入后感觉松动，经校正后二次置入成功；17枚钉道钻孔后出血较多，其中1枚误入横突孔损伤椎动脉，经处理未引起严重后果；术中定位时有33枚螺钉穿出椎弓根，向上进入椎间隙14枚，偏下5枚，偏外8枚，偏内1枚，5枚因方向偏差反复钻孔致椎弓根骨折。32例获得随访，随访时间10～26个月。均获骨性融合。手术后1例患者原有神经症状加重，经过半年康复锻炼症状明显好转。结论：颈椎弓根解剖变异较大，应强调颈椎弓根螺钉置入的个体化，术前除应仔细掌握患者颈椎弓根影像学解剖结构特点外，术中还注意技术操作的要点。Objective：To analyze retrospectively the causes of operative complications and management of cervical pedicle screws placement. Methods：The data of 600 cases with cervical fracture or dislocation treated with cervical pedicle screws. The operative complication was occurred in 36 cases （ 26 male and 10 female;the average age of 38. 9 years ranging from 26 to 68）. According to Frankel degree,there were ll cases of complete spinal cord injuries and 25 of immaturity spinal cord injuries. Results：Two hundreds and four cervical pedicle screws were inserted in 36 cases. Seventy cervical pedicle screws took place deviation of direction, among them 20 loosen screws were successfully corrected in the second time;Bleeding from the pedicle hole was stop by mangement including 1 case injury of vertebral artery in 17 screws. Fourteen screws were wpward into intervertebral space ;5 screws downwards ;8 screws outwards; 1 screw was penetrated in vertebral canal ;5 screws resulted in pedicle fracture because of drilling repeatly. Thirty-two cases had been obtained follow-up, the time of follow-up was from 10 to 26 months. Solid bone fusion was gained in all cases. Conclusion：Anatomic variation of pedicle of cervical vertebra is comparatively large, placement of cervical pedicle screws should be individuate. Carefully evaluation of the morphology of the cervical pedicles preoperative and meticulous techniques of screw placement are essentied in avoiding complications.

关 键 词：颈椎 骨折固定术 内 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]