“徒手法”个体化颈椎椎弓根螺钉技术治疗上颈椎骨折脱位  

Free-hand cervical pedicle screw fixation for upper cervical fracture and instability

作　　者：韩岳[1] 夏群[1] 徐宝山[1] 张继东[1] 苗军[1] 

机构地区：[1]天津医院脊柱外科,300211

出　　处：《中华创伤杂志》2011年第2期110-114,共5页Chinese Journal of Trauma

摘　　要：目的探讨应用颈椎椎弓根钉治疗上颈椎骨折及脱位的临床效果。方法2006年9月－2009年1月，应用颈椎椎弓根钉治疗的上颈椎骨折或脱位的患者15例。其中男11例，女4例；年龄18～60岁，平均41．2岁。寰椎骨折脱位5例，枢椎骨折脱位3例，齿状突陈旧骨折不愈合1例，C2.3骨折脱位2例，无骨折寰枢椎失稳4例。临床主要症状为颈部疼痛或伴有四肢麻木无力、步态不稳。患者术前均行Halo架牵引试行复位。所有患者均采用颈椎椎弓根钉固定并植骨融合，根据术前X线片及CT个体化确定人钉点及置钉角度，徒手法钻出骨性通道，选用22～26mm长的Vertex或Summit钛金属螺钉固定，并行后路椎板间自体或同种异体骨植骨融合。术后1～2d佩戴颈托离床活动。结果本组15例共置入颈椎椎弓根螺钉64枚，均未发生椎动脉和脊髓损伤，无脑脊液漏。术后行X线正、侧位片和CT检查证实损伤节段复位满意、螺钉位置良好。术后疼痛症状基本消失，神经症状较术前有不同程度的改善。14例患者获得随访，时间12～36个月，患者颈椎序列良好，均获得骨性融合，未发生螺钉及钛棒的松动、脱出及折断。神经损伤症状较术前明显改善。结论颈椎椎弓根钉是颈椎后路手术中坚强的固定方法，只要掌握手术操作技巧，严格个体化置钉，颈椎椎弓根钉具有固定可靠、术后并发症少、融合率高等优势，具有良好的临床疗效。Objective To evaluate the clinical effect of the free-hand cervical pediele screw fixa- tion in treatment of the upper cervical fracture and instability. Methods A retrospective review was performed on 15 patients with upper cervical fracture and instability treated with cervical pedicle screw fixation and fusion from September 2006 to January 2009. There were 11 males and 4 females, at average age of 41.2 years （range, 18-60 years）. Of all, there were five patients with atlas fracture and disloca- tion （including three simple anterior arch fractures and two Jefferson fractures ） , three with axis fracture and dislocation, one with dens fractures plus nonunion, two with C：.3 fracture and dislocation and four with atlantoaxial instability without fracture. The main clinical complaints included local neck pain and/or tetraplegia. Halo traction was recommended to restore the cervical sequence preoperatively in all patients. All 15 patients were treated by cervical pedicle screw-rods internal fixation and bone graft fusion. During the operation, the point and angle of the implanted pedicle screws were determined by preoperative X-ray and CT scan and the bony channel drilled with free-hand before implantation of the Summit or Vertex ped- icle screws （22-26 mm long） and posterior interlaminar autologous or allogeneic bone fusion. Patients could get out of bed with neck collar at days 1-2 after operation. Results A total of 64 cervical pedicle screws were implanted in all 15 patients, with no vertebral artery injury, spinal cord injury or cerebrospihal fluid leakage. Postoperative X-ray and CT scan confirmed satisfactory internal fixation. The clinical symptoms were improved significantly. Fourteen patients were followed up for 12-36 months, which showed bony fusion, with no looseness or breakage of the screws. Neurologic impairment was improved in all patients, with no complications associated with the cervical pedicle screw. Conclusions Cervical pedicle screw internal fixation can reestablish the upper c

关 键 词：颈椎 脊柱骨折 脱位 

分 类 号：R686[医药卫生—骨科学]