枢椎椎板螺钉在上颈椎后路固定术中的应用

发布时间：2018-04-11 04:00

本文选题：枢椎 + 骨螺丝　；参考：《脊柱外科杂志》2016年06期

【摘要】：目的探讨枢椎椎板螺钉固定术应用于上颈椎后路融合内固定术中的可行性。方法回顾性分析本院2012年1月—2014年12月在上颈椎后路融合固定术中采用枢椎椎板螺钉固定的19例患者资料,术中根据枢椎椎弓根是否存在缺如、细小等情况,选择置入双侧枢椎椎板螺钉或单侧枢椎椎板螺钉并对侧椎弓根螺钉,联合枕骨板螺钉和/或寰椎侧块螺钉。15例上颈椎畸形患者均有不同程度脊髓功能损害表现,日本骨科学会(JOA)评分为5~15分,平均11.5分。4例外伤性寰枢椎骨折患者有后颈部疼痛及活动障碍,疼痛视觉模拟量表(VAS)评分为2~7分,平均4.5分。术后复查患者影像学资料,观察内固定位置及植骨融合情况。结果所有手术顺利完成,未发生椎动脉、脊髓等损伤。术后复查CT,显示所有枢椎椎板螺钉位置良好,均未突破内侧皮质骨。随访时X线、CT示螺钉位置良好,无松动及断钉。所有患者术后12个月植骨均融合,上颈椎畸形患者神经功能均有不同程度改善,JOA评分为13~17分,平均15.3分。外伤性寰枢椎骨折患者颈部疼痛及活动障碍明显改善,VAS评分为0~2分,平均1.0分。结论枢椎椎板螺钉固定在上颈椎后路固定手术中方法简单安全、效果良好,对于无法行枢椎椎弓根螺钉固定的患者,枢椎椎板螺钉固定是一种安全有效的替代方法。
[Abstract]:Objective to investigate the feasibility of laminar screw fixation in posterior cervical fusion and internal fixation.Methods from January 2012 to December 2014, we retrospectively analyzed the data of 19 patients who were treated with axial laminar screw fixation during posterior cervical fusion fixation, according to the absence and small size of the pedicle of the axial vertebrae.Bilateral laminar screw or unilateral axial laminar screw with contralateral pedicle screw, combined occipital plate screw and / or atlas lateral mass screw. 15 patients with upper cervical vertebra malformation had different degree of spinal cord dysfunction.The JOAA score of Japanese orthopedic society was 5 ~ 15, with an average score of 11.5. 4 cases of traumatic atlantoaxial fractures had posterior neck pain and dyskinesia. The visual analogue scale of pain (VAS) score was 2 ~ 7, with an average of 4.5 points.After operation, the imaging data of the patients were reviewed, and the position of internal fixation and bone graft fusion were observed.Results all the operations were completed successfully and no vertebral artery or spinal cord injury occurred.All axial laminar screws were found to be in good position and no breakthrough of medial cortical bone was found.X-ray and CT showed that the screw was in good position, no loosening and broken nail.All the patients were fused 12 months after operation. The neurological function of the patients with upper cervical vertebra malformation was improved in varying degrees. The JOA score was 13 ~ 17, with an average of 15.3.The cervical pain and dyskinesia in patients with traumatic atlantoaxial fractures were significantly improved with a VAS score of 0 ~ 2 (mean 1.0).Conclusion the method of laminar screw fixation is simple, safe and effective for the patients who can not fix the pedicle screw of the axial vertebrae, and it is a safe and effective alternative method for the patients who can not be fixed with the pedicle screw of the axial vertebrae.
【作者单位】：上海交通大学医学院附属仁济医院骨科;
【分类号】：R687.32

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