后路椎板钉固定治疗难复性颈椎小关节骨折脱位  

Posterior cervical laminar screw fixation for refractory cervical facet fracture and dislocation

作　　者：孙军战 俞军卫 黄升云[1] SUN Jun-zhan;YU Jun-wei;HUANG Sheng-yun(Department of Orthopaedic,The 901"Hospital,Joint Logistics Support Force of PLA,Hefei 230031,China)

机构地区：[1]中国人民解放军联勤保障部队第九○一医院脊柱外科,安徽合肥230031

出　　处：《中国矫形外科杂志》2024年第8期755-758,763,共5页Orthopedic Journal of China

摘　　要：[目的]介绍后路椎板钉固定治疗难复性颈椎小关节骨折脱位的手术技术和初步临床结果。[方法]对7例颈椎小关节骨折脱位颅骨牵引复位失败患者,行颈后路切开复位椎板螺钉固定植骨融合。沿颈棘突后正中线切开,项韧带进入暴露,剥离脱位侧椎旁肌至侧块外缘,包含上下共3个椎体,调整牵引重量及方向,在神经剥离子引导下先复位脱位小关节,在伤椎及上下临椎棘突基底部和椎板交界偏棘突处,指向对侧侧块中心点,在对侧椎板内置入万向螺钉,连接棒塑形后固定。将固定的节段行侧块间植骨融合。[结果]所有患者均顺利完成手术,术中无神经、血管损伤等严重并发症。手术时间平均(95.7±10.2) min,术中出血量平均(43.0±7.2) ml。7例患者8处小关节骨折脱位均得到复位,置入螺钉无腹侧椎板皮质穿出。所有植骨均达到融合,融合时间平均(2.4±0.4)个月,无内置物松动及断裂,无关节再脱位者。[结论]治疗难复性颈椎小关节骨折脱位,后路椎板钉固定与侧块螺钉相比,是一种更简便、安全可行的方法。[Objective] To introduce the surgical technique and preliminary clinical results of posterior cervical laminar screw fixation for refractory cervical facet fracture and dislocation. [Methods] A total of 7 patients who failed to skull traction reduction of cervical facet fracture and dislocation were treated with posterior open reduction, laminar screw fixation and bone grafting. A posterior midline incision was made to reveal cervical spinous process, facet and ligaments. As paravertebral muscle of the dislocated side was retracted to the outer edge of the lateral mass, a total of 3 segments were exposed, including the affected, as well as the above and below adjacent segments. Adjusting the traction weight and direction, the dislocated facet joint was reduced under the guidance of the nerve stripper. A universal screw was inserted into the contralateral lamina at the base of the spinous process aiming the center of the contralateral mass individually in the 3segments. A linking rod was shaped and fastened with the 3 screws to finish fixation, with bone autograft placed on the affected side. [Results] All patients were successfully operated on without nerve, vascular injury and other serious complications, while with operative time of(95.7±10.2) min, and intraoperative blood loss of(43.0±7.2) ml. All 8 facet fractures and dislocations in the 7 patients were reduced, without ventral laminar cortex perforated by screws. All of them had the involved segments fused with an average fusion time of(2.4±0.4)months, and no implant loosening and fracture, no re-dislocation were found in anyone of them. [Conclusion] Compared with the lateral mass screw fixation, the lamina screw fixation may be a more convenient, safe and feasible method for the treatment of irreducible cervical facet fracture and dislocation.

关 键 词：颈椎 关节突骨折脱位 椎板螺钉固定 

分 类 号：R683.2[医药卫生—骨科学]