撑开器辅助外螺纹环钻在颈椎前路减压中的应用  

Thread Trephine Supported by Distracter in Use of Anterior Cervical Decompression

作　　者：史峰军[1] 刘东[1] 刁振斌[1] 宋银冬[1] 于泉[1] 关继奎[1] 

机构地区：[1]大庆油田总医院,黑龙江大庆163001

出　　处：《中国伤残医学》2009年第1期1-2,共2页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:自行设计一种带外螺纹环钻,与撑开器联合应用,以获得简单、安全快捷的颈椎前路减压效果,分析单纯用环钻或撑开器的利弊。方法:用撑开器辅助螺纹环钻进行颈椎前路减压426例,其中颈椎间盘突出344例,后纵韧带骨化1 3例,下颈椎骨折56例,下颈椎肿瘤1 3例。术中显露病变节段,在撑开状态下用外螺纹环钻切除突出的间盘、骨化灶,突入椎管的骨块、肿瘤。颈问盘突出与创伤病例,减压后植骨钛板固定。颈椎肿瘤病例减压后用克氏针骨水泥重建椎体、钛板固定。结果:单节段颈问盘突出平均减压时间为4分钟,颈椎OPLL为1 8分钟。颈椎骨折为6分钟,颈椎肿瘤为14分钟。4例颈椎骨折合并截瘫病例术后无改善,其余422例术后神经症状明显改善。结论:撑开器与带外螺纹环钻联合座用是简单安全的减压技术,恰好克服二者各自缺点,利用其优点:1.可扩大椎间孔。2.恢复颈椎生理前凸曲度。3.切除骨质较少,仅切除椎体上、下终板后1/3少许骨质及突入椎管骨刺。4.植入骨块或cage时容易,无需重力击入,对脊髓震荡轻。5.取下撑开器时对植入物有加压稳定作用。Objetive： To design a new trephine with thread outside which combined with distraeter was used for anterior cervical decompression to obtain a simple, safe and effective result, analyse advantages and disadvantages of simple using trephine or dis- tracter. Methods.. 426 cases underwent the treatment of anterior decompression by combining the thread trephine and the distracter. Including 344 cases with cervical disc herniation, 13 cases with ossification of the posterior longitudinal ligament, and 56 cases with cervical spine fracture, 13 cases with cervical cancer. In the state of distraction, resect the disk, ossification, bone and tumour protruded into spinal eannal by the thread trephine. Cervical disc and trauma cases were treated by autologous bone graft fusion and plate fixation. Turnout of cervical vertebrae cases were reconstructed by needle--bone cement, plate fixation after decompression. Results： Average time for single segment decompression of the cervical disc herniation 4 minutes, 18 minutes for cervical OPLL, 6 minutes for cervical fracture, 14 minutes for cervical tumour. Except 4 cases of cervical spine fracture with paraplegia were not relief, the postoperative neurological symptoms of the remaining 422 cases were improved significantly. Conclusion： Application to anterior cervical decompression by combining the thread trephine and the distracter a simple, safe technique, which overcomes their shortcomings and takes its advantages. 1, to expand intervertebral foramina. 2,restore cervical lordosis. 3, less bone resection, only resect 1/3 of the back endplate and a small bone spur potruding into the spinal. 4, to implant bone grafts or cage easily without gravity blow implants when removing the distraction.

关 键 词：颈椎 撑开器 环钻 前路减压 

分 类 号：R681.5[医药卫生—骨科学]