内侧"in-out-in"枢椎椎弓根螺钉在上颈椎手术中的应用研究  

Application of medial"in-out-in"axis pedicle screw in upper cervical spine surgery

作　　者：高坤[1] 高延征[1] 邵佳 毛克政 张修儒[1] Gao Kun;Gao Yanzheng;Shao Jia;Mao Kezheng;Zhang Xiuru(Department of Spine and Spinal Cord Surgery,He'nan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院脊柱脊髓科,郑州450003

出　　处：《中华神经医学杂志》2022年第8期789-794,共6页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金面上项目(82172438)。

摘　　要：目的探讨上颈椎手术中应用内侧"in-out-in"枢椎椎弓根螺钉治疗寰枢椎脱位或不稳的临床疗效。方法选择河南省人民医院脊柱脊髓科自2017年1月至2020年1月收治的31例寰枢椎脱位或不稳患者进行研究,其中17例患者单侧椎弓根狭窄(优势椎动脉15例,单侧椎动脉2例),于该侧置入内侧"in-out-in"枢椎椎弓根螺钉,另一侧置入常规枢椎椎弓根螺钉;14例患者双侧椎弓根狭窄(优势椎动脉13例,单侧椎动脉1例),于优势或单侧椎动脉侧置入内侧"in-out-in"枢椎椎弓根螺钉,另一侧置入内侧或外侧"in-out-in"枢椎椎弓根螺钉。术前及术后5 d、3个月、6个月、12个月时对所有患者行X线、CT、MRI等检查,对比观察植骨融合情况;收集术前及术后7 d、3个月、6个月、末次随访时所有患者的视觉模拟评分(VAS)、日本矫形外科协会(JOA)评分,对比评估患者的临床疗效。结果本组患者的手术时间为(164.2±28.3)min(136~224 min),术中出血量为(283.6±74.5)mL(180~560 mL),且均无脊髓血管损伤及其他严重并发症发生。术后2例发生脑脊液漏,延迟至8 d拔出引流管,伤口一期愈合;1例术中螺钉远端未进入椎体,远端攻丝后再次拧入螺钉进入椎体。本组患者平均随访13个月(9~25个月),术后6个月影像学检查见无内固定松动、断裂发生,植骨融合;术后7 d、3个月、6个月及末次随访时VAS评分分别为(1.56±0.98)分、(1.13±1.01)分、(1.11±0.86)分及(1.09±0.91)分,均较术前[(3.52±1.97)分]明显降低,差异均有统计学意义(P<0.05);术后7 d、3个月、6个月及末次随访时JOA评分分别为(11.8±2.1)分、(12.3±1.9)分、(12.5±2.2)分及(12.6±1.8)分,均较术前[(8.2±1.7)分]明显升高,差异均有统计学意义(P<0.05)。结论在上颈椎手术中应用内侧"in-out-in"枢椎椎弓根螺钉后路融合内固定治疗寰枢椎脱位或不稳的疗效较好。Objective To investigate the clinical efficacy of medial"in-out-in"axial pedicle screw in the treatment of atlantoaxial dislocation or instability during upper cervical spine surgery.Methods Thirty-one patients with atlantoaxial dislocation or instability,admitted to our hospital from January 2017 to January 2020,were chosen in our study;17 patients were with unilateral stenosis at the pedicle of vertebral arch,including 15 with dominant vertebral artery and 2 with unilateral vertebral artery,and medial"in-out-in"axis pedicle screw was placed on this side and conventionally axis pedicle screw was implanted on the other side;14 patients were with bilateral stenosis at the pedicle of vertebral arch,including 13 with dominant vertebral artery and one with unilateral vertebral artery,and the medial"in-out-in"axial pedicle screw weas placed on the side of the dominant or unilateral vertebral artery and the medial or lateral"in-out-in"axial pedicle screw was inserted on the other side.X-ray,CT,and MRI were performed before,and 5 d and 3,6,and 12 months after surgery to observe the fusion of bone grafts.Scores of visual analogue scale(VAS)and Japanese Orthopedic Association(JOA)were compared before surgery,and 7 d,and 3 and 6 months after surgery,and during the last follow-up to evaluate the clinical efficacy of these patients.Results The surgical time was(164.2±28.3)min(136-224 min);the intraoperative blood loss was(283.6±74.5)mL(180-560 mL),and there was no spinal cord vascular injury or other serious complications.Two patients had cerebrospinal fluid leakage after surgery,the drainage tube was pulled out after a delay of 8 d,and the wounds healed at one stage.The distal end of the screw did not enter the vertebral body of one patient during the surgery,and the screw was inserted again after the distal end was tapped to enter the vertebral body.Follow up for 9-25 months was performed in all patients,with an average of 13 months.The imaging examination showed no loosening of internal fixation,fracture,or fusion of bo

关 键 词：寰枢椎脱位 椎弓根狭窄 枢椎椎弓根螺钉 椎动脉 上颈椎固定 

分 类 号：R687.3[医药卫生—骨科学]