基于第7颈椎解剖学研究的新徒手置钉方法的临床研究  

A clinical study of a novel manual screw placement based on anatomical study of the 7th cervical vertebra

作　　者：范钦玮 廖文胜 高延征[2] 朱忠培[1] 陈洪巍 朱一鹏 郭亮兵[3] Fan Qinwei;Liao Wensheng;Gao Yanzheng;Zhu Zhongpei;Chen Hongwei;Zhu Yipeng;Guo Liangbing(Department of Orthopedics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Spinal Surgery,The People's Hospital of Henan Province,Zhengzhou 450003,China;The Second Department of Spine,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨外科,郑州450052 [2]河南省人民医院脊柱脊髓外科,郑州450003 [3]郑州市骨科医院脊柱二科,郑州450052

出　　处：《中华创伤骨科杂志》2023年第4期335-340,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的:将C 7椎弓根螺钉新徒手置钉方法应用于颈胸椎交界区后路手术,评价其可行性、准确性、有效性及安全性。方法:回顾性研究2015年3月至2021年7月期间郑州大学第一附属医院应用C 7椎弓根新徒手置钉方法治疗的35例下颈椎或颈胸交界区伤病患者资料。男16例,女19例;年龄(52.7±13.2)岁。确认C 7椎弓根螺钉的进钉点。将C 7椎板上缘与上关节突内侧缘交点记为A点,下关节突外侧缘与横突下缘交点记为B点,以AB连线的中外1/3交点处作为进钉点,以与椎板连线垂直或稍向头侧倾斜和外倾30°~40°为置钉角度。记录并比较左、右侧术后C 7椎弓根使用螺钉的置钉参数(长度、直径及置钉角度)证明该置钉方法的可行性;依据Rampersaud法对术后1周、6个月螺钉位置进行分级,评估该方法置钉的准确性;比较术前、术后1周及术后6个月疼痛视觉模拟评分(VAS)、日本骨科协会评分(JOA)和JOA改善率评估该方法的有效性;统计术后并发症发生情况,以评估该方法的安全性。术后6个月行CT检查了解螺钉有无松动、移位和断裂等情况。结果:所有患者随访(9.8±1.7)个月。左、右侧置钉长度、直径及置钉角度比较差异均无统计学意义(P>0.05)。共使用66枚C 7椎弓根螺钉,术后1周、6个月螺钉位置等级无变化,64枚螺钉置钉等级为A级,2枚螺钉置钉等级为B级,无C、D级螺钉。术前、术后1周、6个月VAS评分分别为(4.4±1.7)、(3.8±1.0)、(1.1±1.1)分,JOA评分分别为(6.7±2.2)、(13.2±1.5)、(15.3±1.2)分,术后1周、术后6个月VAS评分、JOA评分均较术前有不同程度改善,差异均有统计学意义(P<0.05);术后1周、6个月的JOA改善率分别为62.7%±13.3%、83.9%±11.6%。未出现与C 7椎弓根置钉相关并发症;无伤口血肿、感染等并发症。术后6个月随访,未发现螺钉松动、移位和断裂。结论:新型C 7椎弓根螺钉置钉法可行、准确、有效、安全。Objective To evaluate the feasibility,accuracy,effectiveness and safety of a novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction.Methods A retrospective case series study was conducted to analyze the 35 patients with injury to the lower cervical spine or cervicothoracic junction who had been treated by a novel manual placement of cervical 7 pedicle screws at Department of Orthopedics,The First Affiliated Hospital of Zhengzhou University from March 2015 to July 2021.There were 16 males and 19 females,with an age of(52.7±13.2)years.The core of this placement was to determine the entry point of cervical 7 pedicle screws.After the intersection of the upper edge of the cervical 7 lamina and the medial edge of the superior articular process was recorded as point A while the intersection of the lateral edge of the inferior articular process and the lower edge of the transverse process as point B,the intersection of the outer and middle 1/3 of the AB line was taken as the screw entry point,with the screw placement angle perpendicular to the lamina line or slightly inclined from 30°to 40°to the head side and outward.The length,diameter and placement angle of the cervical 7 pedicle screws were recorded and compared postoperatively between the left and right sides to explore the feasibility of this novel manual placement.According to the Rampersaud method,the screw positions were graded 1 week and 6 months after operation to evaluate the accuracy of this manual placement.The visual analogue scale(VAS)and the Japanese Orthopaedic Association(JOA)score were compared between preoperation,1 week and 6 months after operation to evaluate the effectiveness of this placement.The postoperative complications were counted to evaluate the safety of this method.Loosening,displacement and breakage of the screws were observed by CT scanning at 6 months after operation.Results This case series was followed up for(9.8±1.7)months.There was no significant difference in the length,diam

关 键 词：颈椎 内固定器 解剖学研究 椎弓根螺钉 第7颈椎 

分 类 号：R687.3[医药卫生—骨科学]