下颈椎椎弓根螺钉并发症分析  

Complications of lower cervical pedicle screw fixation

作　　者：王迎松[1] 杨振东[1] 张颖[1] 鲁宁[1] 刘路平[1] 陈鸿[1] 赵智[1] 解京明[1] 

机构地区：[1]昆明医学院第二附属医院骨科,昆明650101

出　　处：《中华创伤杂志》2010年第7期595-600,共6页Chinese Journal of Trauma

摘　　要：目的 分析下颈椎椎弓根螺钉的并发症,总结其手术技巧和经验.方法 回顾性分析2004年7月-2008年3月采用C3～7椎弓根螺钉治疗的各类颈椎损伤患者112例（共使用624枚螺钉）.创伤患者66例均行后路I期复位,双侧椎弓根钉棒/板系统固定;非创伤患者46例,予椎管减压,后路钉棒/板系统矫形或重建稳定性.所有患者结合术中颈椎椎弓根四壁探查、术后手术节段椎弓根CT扫描及颈椎左、右斜位X线片,观察螺钉在椎弓根内的位置、角度以及与椎弓根壁的关系和距离.结果 椎弓根壁损伤77枚（12.3%）,其中外侧壁损伤68枚（10.9%）,包括Ⅰ度损伤56枚（9.0%）,Ⅱ度损伤12枚（1.9%）;下壁损伤9枚（1.4%）.随访时间3～24个月（平均9.8个月）.断钉2枚（0.3%）,松动1枚（0.2%）.未发现植骨不融合、假关节形成或节段不稳表现.结论 下颈椎椎弓根置钉的并发症发生率较低,是相对安全的操作方法.术前详细分析影像学资料、熟悉局部解剖特点、掌握合理的置钉技术,可以有效减少和避免并发症的发生.Objective To analyze the complications of lower cervical pedicle screw fixation in treatment of the cervical spine disorders and discuss the operative technique. Methods A retrospective study was made in 104 patients with different cervical injuries treated by C3-7 pedicle screw fixation （total use of 624 screws） from July 2004 to March 2008. One stage posterior reduction and fixation using lower cervical pedicle screw-rod system or screw-plat system were performed in 66 traumatic patients and the nerve condition was evaluated by Frankel criteria system. For 46 non-traumatic patients, laminoplasty or laminectomy was performed for decompression, and cervical pedicle screw-rod system or screw-plat system were used in deformity correction and stability reconstruction. Based on exploration to quadric walls of vertebral pedicle during operation, postoperative thin-slice CT scan along operative vertebra segments＇ pedicle and bilateral oblique position X-ray of cervical spine in all patients, we evaluated screw location, screw angle as well as the distance and the relation between the screws and the internal pedicle wall or lateral wall. Results In this study, the lower cervical pedicles of 104 patients were fixated with 624 screws including 77 screws （12.34% ） for pedicle wall damage, 68 screws （10.8% ） for the lateral wall injury, 56 screws （8.97% ） for grade Ⅰ violation of pedicles, 12 screws （1.92% ） for grade II violation of pedicles Ⅱ violation of pedicles and 9 screws （1.44% ） for inferior wall injury of cervical pedicle. The follow-up lasted for 3-24 months （average 9. 8 months）, which showed breakage of two screws （0.32% ） and loosening of one screw （0.16% ）. Conclusions Lower cervical pedicle screw fixation has relatively low incidence of complications and is a safe operation. The complications can be minimized by sufficient preoperative imaging studies of the pedicles, familiar with the feature of opography and reasonable surgery technique.

关 键 词：脊柱损伤 颈椎 内固定器 并发症 

分 类 号：R686[医药卫生—骨科学]