颈椎椎弓根技术在下颈椎疾患应用的临床疗效观察  

Clinical efficacy of cervical pedicle technique in lower cervical spine disease

作　　者：贾卫斗[1] 贾薇薇[2] 杨飞[1] 杨博贵[1] 郑铁钢[1] 许英杰[1] 云得才[1] 孙华[1] 

机构地区：[1]解放军第251医院,河北张家口075000 [2]北京军区总医院,北京100700

出　　处：《中国矫形外科杂志》2010年第6期457-460,共4页Orthopedic Journal of China

摘　　要：[目的]探讨颈椎椎弓根内固定技术在下位颈椎疾患应用的临床疗效。[方法]回顾2000年8月-2007年8月对118例患者,置入490枚椎弓根螺钉治疗下颈椎疾患,其中颈椎骨折脱位81例,颈椎病合并椎管狭窄21例,颈椎黄韧带骨化11例,颈椎后突畸形2例,强直性脊柱炎3例。术前应用图像存储传输系统（简称PACS）,采用X线片及64排CT片,对患者下位颈椎椎弓根的冠状位、矢状位、横断位进行精确测量,得出椎弓根的长度、宽度、高度、向内侧倾斜、向头侧倾斜角度的数据值,以指导术中选钉及置钉。术中应用自行研制的颈椎椎弓根定位导向器,准确定位入钉点及角度,打孔、置钉、固定。[结果]术后102例患者获13-65个月随访,平均随访时间18.95个月。采用JOA评分标准[1],结果：优82例,良15例,可3例,差2例,优良率95.01%。术后X线及CT示固定节段稳定,颈椎椎体高度和生理曲度维持良好,内固定位置良好,无植骨块脱出或钢板、螺钉松动、断裂等并发症,无脊髓及椎动脉损伤。2例患者植骨块吸收未融合,融合率为97.04%。[结论]下颈椎椎弓根螺钉技术是相对安全的操作,可用于需从后路固定的颈椎疾患病例,可维持良好的颈椎生理曲度,远期临床效果满意。[Objective]To investigate the clinical efficacy of pedicle screw internal fixation in treatment of lower cervical disease.[Method]A total of 490 pedicle screws were used in the treatment of lower cervical disease of 118 patients from August 2000 to August 2007,including 81 lower cervical spine fracture and dislocation,21 cervical spondylosis associated with spinal stenosis,11 cervical ossification of yellow ligament,2 cervical kyphosis deformity,3 ankylosing spondylitis.The picture archiving and communication system（PACS） was used preoperatively.X-ray and 64-slice helical CT film was also used to precisely measure the lower cervical pedicle in the positions of coronal,sagittal,axial.The length,width,height of the pedicle were measured to acquire the inside inclined angle and cephalic inclined angle,in order to guide the selection and application of screws.Self-developed positioning guider was used to set the position and angle of screw accurately.[Result]Totally 102 patients were followed up for an average 18.95 months（13-65 months）.According to JOA classification,excellent result was achieved in 82 cases,good in 15 cases,fair in 3 cases,poor in 2 cases,with the good-to-excellent rate of 95.01%.X-ray and CT showed stable fixation segments,good cervical height and lordosis,good internal postion,and no loosening,broken of implant,no injury of spinal cord and vertebral artery.Non-Absorb were found in 2 cases.The fusion rate was 97.04%.[Conclusion]The lower cervical pedicle screw technique is safe in treatment of posterior cervical spine diseases.The cervical physiological curve can be maintained in a good position,the long-term clinical result is satisfactory.

关 键 词：颈椎椎弓根定位导向器 图像存储传输系统 下颈椎 椎弓根 螺钉 

分 类 号：R687.3[医药卫生—骨科学]