寰枢椎后路专用钉棒固定器械的研制与初步临床应用  

Design and preliminary clinical application of specified posterior atlantoaxial screw rod fixation instruments

作　　者：马向阳[1] 杨进城[1] 邹小宝[1] 陈树金 杨敏[1] 王宾宾[1] 邱锋[1] 夏虹[1] 尹庆水[1] MA Xiangyang;YANG Jincheng;ZOU Xiaobao;CHEN Shujin;YANG Min;WANG Binbin;QIU Feng;XIA Hong;YIN Qingshui(Department of spinal surgery, Orthopaedics Hospital, Guangzhou General Hospital of Guangzhou Military Command, Institute of Traumatic Orthopaedics of PLA, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Guangzhou, Guangdong 510010, China)

机构地区：[1]广州军区广州总医院骨科医院脊柱外科全军创伤骨科研究所全军热区创伤救治与组织修复重点实验室,510010

出　　处：《中国骨科临床与基础研究杂志》2016年第5期261-268,共8页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省科技计划项目(2015B020233013)

摘　　要：目的研制寰枢椎后路专用的钉棒内固定器械，探讨其初步临床应用效果。方法基于现有颈椎后路钉棒内固定系统在寰枢椎脱位实践应用中的不足，设计研制一套专门用于寰枢椎后路手术的新型钉棒内固定系统，包括寰椎提拉螺钉、枢椎支点螺钉、自动防旋固定棒、钉尾横连以及锥形螺纹丝攻等配套安装器械。气管插管全麻下将该新型内固定器械系统应用于6例患者，观察其应用效果。结果本组6例患者均成功施行寰枢椎后路钉棒复位固定术，其中非融合固定3例、植骨融合固定3例。手术时间60～150min，平均手术时间95min；术中出血量30～80mL，平均术中出血量50mL，无脊髓及椎动脉损伤并发症发生。新型内固定系统的螺钉、固定棒、横连均一次置入到位，无须反复调整及额外的器械辅助。术后X线片、CT、MRI复查结果显示寰枢椎脱位复位满意，脊髓压迫解除。结论研制的寰枢椎后路专用钉棒固定系统设计新颖独到，手术操作简便易行，初步临床效果满意，具有良好的应用前景。Objective To design screw rod internal fixation instruments specially used for posterioratlantoaxial surgery, and to observe its preliminary clinical applications. Methods In view of the shortcomings ofcurrent posterior cervical screw rod fixation system for atlantoaxial dislocation during the clinical practice, a setof new specified posterior atlantoaxial screw rod fixation system was designed, including C1 reduction screw, C2fulcrum screw, automatic anti-rotation fixation rod, transverse-link of screw tail as well as other matched installation instruments such as cone-shaped screw tap. Six patients performed posterior atlantoaxial screw rodfixation with this new-type system under intratracheal general anesthesia, and the applications were observed.Results All 6 patients underwent the operations successfully, including 3 cases of fixation without bone graftfusion and 3 of fixation with bone graft fusion. The average operative time was 95 min (60-150 min), and theaverage intraoperative estimate blood loss was 50 mL (30-80 mL). No spinal cord or vertebral artery injurieswere found during the operation. Screw, fixation rod and transverse-link of this new fixation system wereinstalled in place at one go, with no repeated adjustments or assistance by additional tools. Postoperative X-ray,CT and MRI results showed a satisfied reduction and decompression. Conclusion The specified posterioratlantoaxial screw rod fixation system is a novel and creative device, not only simplify the operation procedure,but also has a satisfactory preliminary clinical effects and excellent application prospect.

关 键 词：寰枢关节 脱位 关节不稳定性 关节固定术 内固定器 钉棒内固定系统 

分 类 号：R687.32[医药卫生—骨科学]