下颈椎椎弓根螺钉置钉技巧探讨  

Operative skill of lower cervical transpedicle screw

作　　者：解京明[1] 王迎松[1] 张颖[1] 鲁宁[1] 曹锦[1] 张漾杰[1] 

机构地区：[1]昆明医学院第二附属医院骨科,昆明650101

出　　处：《中国矫形外科杂志》2007年第10期745-748,共4页Orthopedic Journal of China

摘　　要：[目的]探讨下颈椎椎弓根螺钉的置钉技巧和手术体会。[方法]2004年7月～2006年4月，在前期尸体标本操作的基础上，C型臂引导下采用下颈椎椎弓根螺钉技术治疗颈椎疾患15例。常规后路，术中显露侧块至其外侧缘，辨清上关节突关节面基底部上缘；选择侧块外缘内5mm，上关节突关节面基底部下方3mm处为进钉点，球磨去皮质。2mm手钻开路并探子确认，保持与上终板平行并40°-45°内倾角。不攻丝置入3．5mm皮质骨螺钉。[结果]除1枚C4螺钉未能成功外，共计置入C3-7下颈椎椎弓根螺钉86枚，平均螺钉长度（26±1．6）mm，CT下各钉内倾角度平均值37．9°±5．4°。术中2枚（2．9％）在开路时发生钉道活动性出血。术后CT示椎弓根壁损伤6枚（8．8％）。术后无神经血管损伤并发症。[结论]颈椎椎弓根螺钉技术相对安全，置钉成功的关键是手感。[ Objective]To recommend the detailed operative skill of lower cervical transpedicle screw and peri-operative experience. [Method]From July 2004 to April 2006, based on anatomical research of cadaver, 15 cases involved lower cervical had been treated by transpedicle screws and plate or rod, which assisted in fluoroscopic moniter. Lateral mass needed he revealed completely, thus basilar part of superior articular process could be recognized. The central point of screw inserted were laid on the surface of lateral mass： 5mm inner to the outside border of lateral mass; 3mm below to the inferior of superior articular process. Ball-like burr was used to de-cortical. Made a pathway with 2 nun hand-drill paralleled with the upper end-plate cartilage of the vertebra and maintain abduction angle about 40°-45° with middle line of the vertebra, self-designed pedicle probe was used to ensure safety tunnel of cancellated bone. 3.5 mm cortical screws were adoption and thread was not recommend. [ Result] Eighty-six lower cervical pedicle screws had been inserted successfully in C3-7 vertebra, exclude a failed C4 screw. Average screws length was （26 ± 1.6）mm and abduction angle based on postoperative CT scan was 37.9°±5.4°. Abundant bleeding was occurred while built the pedicel pathway in 2 screws, and there were 6 screws showed perforation of the pedical wall refer to postoperative CT scan. No evidence indicated the complication about injury of vessel or nerve structure.[ Conclusion] The tech- nique of lower cervical transpedicle screw are relatively safet. Successful screw insertion depends on subtile sense of operation doctor＇s hand.

关 键 词：颈椎 椎弓根钉 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]