下颈椎椎弓根螺钉技术的临床应用  

Clinical application of lower cervical transpedicle screws

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,云南昆明650101

出　　处：《颈腰痛杂志》2008年第3期197-201,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的评估下颈椎椎弓根螺钉技术应用于颈椎不稳定的临床意义,并总结其手术技巧和适应征。方法回顾性分析2004年7月-2006年8月,采用颈3-7椎弓根螺钉技术治疗的各类颈椎疾患28例146枚钉。创伤患者18例,Frankel分级评价神经损伤情况。包括3例陈旧性下颈椎脱位,均后路一期复位,双侧椎弓根钉钢板固定;非创伤患者10例,予椎管减压,后路钉棒、板系统矫形或重建稳定性。结果术后CT提示椎弓根壁损伤5枚(3.42%),无1例血管神经损伤表现。随访时间平均9.8(3-24)月。创伤患者Frankel分级无加重,除3例A级患者无恢复外,均有1-3级的脊髓功能恢复,伴发神经根激惹症状减轻或消失;非创伤患者脊髓功能JOA评分由术前6.8分提高至12.5分。结论下颈椎椎弓根螺钉技术是相对安全的操作,可适用于几乎所有需要从后路固定的颈椎病例。重要的是在术前详细分析影像资料,熟悉局部解剖特点,掌握合理的置钉技术,以减少和避免并发症。Objective To evaluate the clinical significance of lower cervical transpedicle screws applicated in cervical unstable patients,and recommend its detailed technique and indications. Methods Since July,2004 to August,2006,28 cases which had been treated using transpedicle screws fixation was involved in this retrospective research. 146 screws had been inserted into C3-7 pedicles. Spinal injuries in 18 traumatic patients,include 3 old dislocation,were evaluated by Frankel criteria. All 18 cases were performed one-stage posterior reduction and fixated by screws combined with bilateral plates. For the rest 10 nontraumatic patients,laminoplasty or laminectomy were chosen for decompression,and screw-rod or plate fixation were used to reconstruct cervical stability. Results There were 5 screws showed doubtful perforation of the pedicle wall refer to postoperation CT scan,but no evidence indicated the complication about injury of vessel or nerve structures. 24 patients underwent mean 9.8 months follow-up. The Frankel scales of traumatic patients had not turned worse than pre-operation and shown 1-3 levels recovered,except 3 cases which appearance complete paralysis. Cervical radiculopathy were relieved or vanished. Cervical myelopathy rated by the JOA score improved to 12.5 points on average contrasted 6.8 points preoperation. Conclusion The technique of lower cervical transpedicle screw are relatively safe,indicated in almost all situations which needed posterior rigid fixation. Complications caused by transpedicle screws can be minimized by sufficient imaging studies and intimate knowledge of anatomical characters, based on rational technique of screw insertion.

关 键 词：颈椎 内固定器 椎弓根 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]