颈椎椎弓根钉棒内固定在颈脊髓损伤手术中的应用  

Application of Cervical Pedicle Screw Fixation in Cervical Spinal Cord Injury

作　　者：黄江[1] 段满生[1] 曹凯[1] 余海滨 刘先明[3] 万宗淼[1] 马勇[1] 黄山虎[1] 韩智敏[1] 舒勇[1] 戴闽[1] 

机构地区：[1]南昌大学第一附属医院骨科,南昌330006 [2]九江市第三人民医院骨科,江西九江332000 [3]萍乡市人民医院骨科,江西萍乡337055

出　　处：《南昌大学学报（医学版）》2012年第11期22-27,39,共7页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫生厅科技计划(20061072;20123034)

摘　　要：目的探讨颈椎椎弓根钉棒内固定技术重建、稳定颈椎,促进颈脊髓功能恢复的疗效。方法采用前瞻性分析,应用颈椎椎弓根钉棒内固定治疗的颈脊髓损伤患者22例,术后进行影像学随访,并在手术前后及随访时对颈脊髓进行Frankel分级及JOA评分。结果全部患者均减压充分,获良好复位、固定,共成功置入104枚椎弓根螺钉,术后CT示8枚螺钉(7.7%)发生偏移外,其余螺钉位于椎弓根内,未见严重手术并发症。18例患者术后获得6～24个月(平均12个月)随访,术后3个月植骨均获良好融合,未发现内固定断裂及松动现象。颈脊髓功能按JOA评分平均增加了8.2分。按Frankel分级:A级3例,均无好转;2例B级转为C级;6例C级转为D级,其余7例C级转为E级。结论颈椎减压/复位后应用椎弓根钉棒内固定技术可早期实现三柱固定,有利于获得及维持术后颈椎的稳定性,能促进颈脊髓功能的改善和恢复。Objective To discuss the curative efficacy of cervical pedicle screw fixation for reconstructing and stabilizing cervical vertebra in promoting functional recovery of cervical spinal cord.Methods A prospective analysis was performed in 22 patients with cervical spinal cord injury who received cervical pedicle screw fixation.All patients were followed up radiologically after operation.Spinal cord function was evaluated according to the Frankel grading system and JOA scores before and after operation.Results All cases achieved full decompression and good reduction with stable fixation.Postoperative CT scan revealed that 8（7.7%） of the 104 successfully implanted pedicle screws perforated the cortex of pedicles.No neurovascular complications occurred in all patients.At 3 months after operation,autograft bone showed good bony union and no internal fixation breakage or loosening was found in the 18 patients who were followed-up for an average of 12 months（range 6 to 24 months）.The JOA scores increased by an average of 8.2 after operation.Frankel grading showed grade A in 3 cases without improvement,grade B converting to grade C in 2,grade C converting to grade D in 6,and grade D converting to grade E in 7.Conclusion Pedicle screw-rod fixation provides instant tri-column fixation to obtain and maintain cervical stability after cervical decompression and/or reduction.This technique promotes the improvement and recovery of cervical spinal cord function.

关 键 词：颈脊髓损伤 颈椎骨折脱位 颈椎管狭窄 椎弓根螺钉 内固定 

分 类 号：R651.2[医药卫生—外科学]