多轴向螺钉-棒椎弓根固定系统植入治疗寰枢椎损伤的特征  

Pedicle screw implant of polyaxial screw and rod system fixation for treatment of atlantoaxial injury

作　　者：李孟军 许海宁 褚秀成 李亮 吉旭彬 于锡欣[2] 

机构地区：[1]东营市人民医院外一科,山东省东营市257091 [2]山东省立医院脊柱外科,山东省济南市250021

出　　处：《中国组织工程研究与临床康复》2007年第29期5705-5708,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:总结应用多轴向钛螺钉-棒系统椎弓根钉植入技术治疗寰枢椎损伤的特点。方法:选择山东省东营市人民医院、加拿大脊柱外科中心、山东省立医院脊柱外科1999-01/2004-01治疗的寰枢椎损伤患者。应用后路多轴向钛螺钉-棒系统固定融合手术治疗38例,固定位置为寰椎(C1)的双侧块和枢椎(C2)的椎弓根,并与46例采用关节突螺钉复合后方椎板下钢丝固定植骨融合进行对比分析。结果:84例患者全部进入结果分析。①治疗组脊髓损伤的治愈率和总有效率(治愈+有效)高于对照组,但差异无显著性(92%,85%,χ2=0.29,P>0.05)。②治疗组对椎动脉孔的入侵率明显低于对照组(5%,30%,χ2=6.99,P<0.05)。③治疗组对椎管的入侵率明显低于对照组(5%,28%,χ2=6.02,P<0.05)。④术后治疗组α角(寰枢椎角)为(26.8±5.42)°,对照组α角为(25.6±5.82)°,两组对比差异无显著性(t=1.27,P>0.05)。⑤治疗组1例轻度错位(≤7mm),1例神经轻度放射痛,术后5个月取出内固定后消失,余无固定松动、椎动脉损伤、神经压迫征发生,3个月融合28例,6个月全部融合。对照组4例出现骨折所致不稳,3例半脱位,5例不融合,6例神经痛。结论:对急性寰、枢椎损伤患者进行C1双侧块和C2椎弓根后路多轴向钉-棒系统固定融合手术治疗方法简单、易于避开椎动脉,定位准确,直视下进行操作,安全性高,固定可靠。AIM： To sum up the characteristics of pedicle screw implant in polyaxial screw and rod system fixation for treating atlantoaxial injury. METHODS： Between January 1999 and January 2004, 38 cases of atlantoaxial injury were treated in Dongying People＇s Hospital, Canadian Center of Spinal Surgery, Department of Spine Surgery, Shandong Provincial Hospital, and received posterior fixation of the C1 lateral mass and the C2 pedicle by polyaxial screw and rod system. While the control group （46 cases） were treated with fixation by transarticular screws combined with posterior wiring and structural bone grafting. Then the treating group and control group were compared. RESULTS： All 84 subjects were involved in the result analysis. ①The healing rate and total effectiveness rate （healing＋effective） of spinal injury were high in treating group than in control group （92%, 85%,χ^2=0.29, P〉0.05）,②The invasion rate onto vertebral artery foramen was obviously higher in treating group than in control group （5%, 30%, χ^2=6.99, P〈0.05）, but that onto vertebral canal was obviously lower （5%, 28%, χ^2=6.02, P〈 0.05）. ③There was no significant difference in α angle （atlantoaxial angle） between the treating group and control group [（26.8±5.42）°, （25.6±5.82）°, t =1.27, P〉0.05].④ln the treating group, one patients presented mild displacement （≤7 mm） and one mild neural radiating pain, which was disappeared after the internal fixation were taken out 5 months later. No fixation loosening, vertebral arterial injury or neural compression was observed. Three months later 28 patients showed fusion and six months later all the subjects were identical. In the control group, 4 subjects occurred fracture-induced instability, 3 subluxation, 5 nonfusion and 6 neural pain. CONCLUSION： Fixation of the atlantoaxial complex using polyaxial-end screw and rod system seems to be a reliable, safe, effective and simple technique and should be considered an efficient alternative to treat

关 键 词：多轴向钛螺钉-棒系统 寰枢椎 骨折脱位 外科学 

分 类 号：R687.3[医药卫生—骨科学]