下颈椎前路椎弓根螺钉内固定的初步临床应用  

Preliminary clinical application of anterior pedicle screw fixation of lower cervical spine

作　　者：王远政[1] 刘洋[1] 陈富[1] 程昀[1] 陈亮[1] 晏铮剑[1] 楚磊[1] 柄珍勇[1] 邓忠良[1] 

机构地区：[1]重庆医科大学附属第二医院骨科,400010

出　　处：《中华创伤杂志》2012年第8期697-702,共6页Chinese Journal of Trauma

基　　金：重庆市卫生局重点课题资助项目（渝卫科2011-1-053）

摘　　要：目的探讨颈椎前路椎弓根螺钉（anterior pediclescrew，APS）内固定技术临床应用的可行性和安全性。方法应用下颈椎APS内固定技术治疗下颈椎损伤患者10例。术前皆行颈椎CT扫描，Mimics软件重建三维模型，测量置钉参数（进钉点、置钉角度和螺钉长度与直径）。采用常规颈前方入路术，显露椎体前壁致两侧外缘，辨清固定椎体上下终板。在X线透视引导下，严格按照术前的置钉参数置钉。术后复查颈椎正、侧位X线片、CT平扫和三维重建及MRI，由放射科医师与非术者骨科医师共同评价。术后1，3，6，12个月随访，并进行评价。结果术中除1枚C4和1枚C7螺钉未能成功置人外，共计置入C3-C7螺钉24枚。术后CT示4枚损伤椎弓根外侧壁。术后1例1周后死于急性心肌梗死，余9例均获随访。按Frankel分级，3例创伤患者中1例A级患者无恢复，但无加重，另2例有2-3级恢复；6例非创伤患者脊髓功能日本骨科学会（JOA）评分平均提高到13．4分，按Hirabayashi法计算，改善率为60．7％。所有受访患者，除2例发生吞咽困难外，余均无并发症发生。各例早期均有骨融合出现。结论下颈椎APS内固定技术可行。置钉成功的关键在于术前个体化置钉参数的测定及术中x线透视技术的运用。Objective To discuss the feasibility and safety of anterior pedicle screw （APS） fixa- tion in treatment of lower cervical spine injuries. Methods A total of 10 patients with lower cervical spine injuries were treated with APS fixation. All the patients received preoperative cervical CT scans, and then three-dimensional model was reconstructed by using Mimics software to measure the screw place- ment parameters （ insertion point, screw placement angle, screw length and diameter）. All APS fixations were performed through anterior cervical approach, and then centrums antetheca and bilateral outer edges were exposed to distinguish the vertebral end plates. Screw insertion was strictly operated under the fluor- oscopic assistance and preoperative screw placement parameters. The postoperative efficacy of APS fixa- tion was evaluated by radiologist and other orthopedist via anteroposterior and lateral radiation, CT scan, three-dimensional model reconstruction and MRI. A follow-up was carried out at 1, 3, 6 and 12 months after operation. Results Except for one screw for C4 and one for C7, another 24 crews for C3-C7 were successfully inserted. Postoperative CT scan demonstrated four screws breaking the outer vertebral wall. Except for one patient suddenly died from acute myocardial infarction one week after operation, the other nine patients received follow-up. Of three trauma patients, one patient at Grade A did not get improve- ment but with no aggravation and two achieved improvement for 2-3 grades according to Frankel grade. A- mong six non-trauma patients, spinal function score by JOA was averagely elevated to 13.4 points, with improvement rate of 60.7% according to Hirabayashi method. There were no serious complications exceptfor two patients of dysphagia among the patients who were followed up. Conclusions APS fixation is feasi- ble for lower cervical spine injuries. The keys to successful screw insertion are preoperative measurement of in- dividualized serew insertion parameters and appropriate application

关 键 词：颈椎 内固定器 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]