高速磨钻辅助下椎弓根钉棒系统治疗颈椎交锁性脱位  

Pedicle screw-rod system assisted with high speed drills for treatment of interlocking dislocation of cervical spine

作　　者：孟志斌[1] 黄涛[1] 冯光 李俊[1] 王挺锐[1] 祝开忠[1] 

机构地区：[1]海南医学院附属医院脊柱骨病科,海口570102 [2]琼海市人民医院骨科

出　　处：《中华创伤杂志》2013年第9期841-844,共4页Chinese Journal of Trauma

摘　　要：目的 探讨应用高速磨钻辅助下颈椎椎弓根钉棒系统治疗下颈椎交锁性脱位的适应证、方法及疗效. 方法 回顾性分析2006年12月-2011年7月应用高速磨钻辅助椎弓根钉棒系统复位固定治疗的13例颈椎交锁性脱位患者临床资料.脱位部位：C3/43例,C4/55例,C55/64例,C6/71例.致伤原因：交通伤7例,高处坠落伤6例.2例无任何神经症状,7例合并中央管损伤综合征,4例截瘫.13例患者均在伤后7d内行高速磨钻辅助后路椎弓根螺钉复位内固定术,采用短节段固定,椎弓根钉置入上下相邻的椎弓根内,在复位撑开钳的配合下解除小关节交锁,并复位固定. 结果 所有患者均获良好复位,13例患者中8例解剖结构完全复位,5例有1～2 mm轻度滑脱.共置入52枚椎弓根螺钉,术中未出现脊髓、神经根或椎动脉损伤,术后X线片及CT显示除3枚螺钉偏移出椎弓根外,其余49枚螺钉完全位于椎弓根内.随访12-36个月,术后上肢感觉、运动功能明显改善.1例术后3个月断钉,但无神经症状. 结论 高速磨钻辅助椎弓根钉棒复位内固定适用于治疗颈椎交锁性脱位,复位过程符合生物力学,同时可行减压治疗.Objective To evaluate the indications,techniques and effects of high speed drill assisted cervical pedicle screw-rod system in treatment of cervical interlocking dislocation.Methods A retrospective review was made on data of 13 cases of cervical interlocking dislocation undergone pedicle screw-rod fixation and reduction with assistance of high speed drills from December 2006 to July 2011.Dislocation localized in C3/4 （n =3）,C4/5 （n =5）,C5/6 （n =4） and C6/7 （n =1） respectively.Causes for injury contained cervical hyperextension due to traffic accidents （n =7） and a fall from the height （n =6）.Two remained neurological intact,seven were combined with syndrome of central canal damage,and four had paraplegia.All the 13 cases received posterior pedicle screw fixation and reduction within 7 days after injury.Pedicle screws were implanted on adjacent segment of cervical spine with unlocking the interlocked small joints by a distraction device.Results All 13 cases obtained good reduction,including eight with complete anatomic reduction and five with 1-2 mm of vertebral slight slippage.Fifty-two screws were inserted and 49 pedicle screws were put in place except for the excursion in three pedicle screws on the postoperative radiographic and CT scans.There was no injury of spinal cord,nerve root or vertebral artery during operation.The patients showed significant improvement in sensory and motor function of the upper extremities in the follow-up of 12-36 months.One case had screw breakage at postoperative three months with no nerve symptoms.Conclusion High speed drill assisted pedicle screw-rod system is suitable for treatment of cervical interlocking dislocation,for its reduction process accords with the biomechanics and allows decompression therapy.

关 键 词：脊柱损伤 颈椎 脱位 椎弓根钉 

分 类 号：R687.3[医药卫生—骨科学]