颈椎侧块螺钉在颈椎疾患中的临床应用

发布时间：2018-07-21 14:03

【摘要】：目的:通过回顾30例颈椎后路手术患者,探讨颈椎侧块螺钉内固定治疗颈椎疾病的有效性及安全性。方法:对2012年07月—2015年06月30例患者采用颈椎侧块螺钉内固定治疗颈椎疾病患者进行回顾性研究(本组病例中颈椎外伤16例,多节段脊髓型颈椎病12例,颈椎后纵韧带骨化1例,颈椎管硬膜外自发性出血1例)。所有患者均采用后路减压,侧块螺钉内固定。其中有2例因考虑颈髓前方有髓核压迫,二期行前路髓核摘除取植骨椎间融合钛板内固定术。所有病例分别在术前,术后,术后6个月采用ASIA评分系统和JOA评分系统对患者的神经功能症状进行临床效果评定,随访患者的复位,植骨融合情况及内固定失效情况。结果:30例患者均获得随访,随访6个月—3.5年,平均2年4个月;术后行X线摄片,颈椎MRI检查;所有颈椎患者均完全复位。术后6个月所有患者均获得良好的骨性融合。16例颈椎外伤患者(ASIA分级),5例A级(完全性颈髓损伤)患者中,1例术后6个月因反复肺部感染导致呼吸衰竭而死亡,2例恢复至B级,2例无恢复;5例B级患者中,4例恢复至C级,1例无恢复;4例C级患者中,3例恢复至E级,1例恢复至D级;2例D级患者均恢复至E级。术前、术后2周和术后6月ASIA分级Kruskal Wallis检验P=0.049。组间两两比较显示术前和术后2周比较差异无显著性(P=0.829),术前和术后6月JOA评分比较差异有显著意义(P=0.024);多节段脊髓型颈椎病12例及颈椎后纵韧带骨化1例,颈椎管硬膜外自发性出血1例,优9例(改善率75%),良4例(改善率50%-75%),可1例(改善率50%)。术前、术后2周和术后6月JOA评分比较差异有显著性,P=0.001(F=23.13)。组间比较显示术前和术后2周JOA评分比较差异无显著性(P=0.087),术前和术后6月JOA评分比较差异有显著意义(P0.001)。所有病例均没有出现神经根,椎动脉,脊髓损伤或损伤加重的并发症。结论:颈椎侧块螺钉内固定具有力学强度好,适应症广,操作安全等优点,术后很大程度上保留了患者颈椎的活动度,是颈椎后路手术中一种安全,可靠的内固定方法。
[Abstract]:Objective: to evaluate the efficacy and safety of cervical lateral mass screw fixation in the treatment of cervical spine diseases. Methods: from July 2012 to June 2015, 30 patients with cervical vertebrae disease were treated with cervical lateral mass screw fixation (16 cases of cervical trauma and 12 cases of multilevel cervical Spondylotic myelopathy). Ossification of posterior longitudinal ligament (1 case) and spontaneous epidural hemorrhage (1 case). All patients were treated with posterior decompression and lateral mass screw fixation. Among them, two cases were treated with anterior removal of nucleus pulposus and intervertebral fusion titanium plate fixation because of the compression of anterior medullary nucleus. The clinical effects of neurologic symptoms were evaluated by Asia scoring system and JOA scoring system before and 6 months after operation. The patients were followed up for reduction, bone graft fusion and failure of internal fixation. Results all 30 cases were followed up from 6 months to 3.5 years, with an average of 2 years and 4 months. 6 months after operation all patients obtained good osseous fusion. 16 patients with cervical spine trauma (Asia grade) and 5 patients with grade A (complete cervical spinal cord injury). 1 patient died of respiratory failure due to recurrent pulmonary infection 6 months after operation. Among the 5 patients with grade B, 4 cases recovered to grade C, 1 case had no recovery, 4 cases recovered to grade C, 3 cases recovered to grade E, 1 case recovered to grade D, 2 cases of grade D recovered to grade E. Before operation, 2 weeks after operation and 6 months after operation, Asia grade Kruskal Wallis was examined by P0. 049. There was no significant difference between the two groups before and after operation (P0. 829), there was significant difference in JOA score between preoperative and postoperative 6 months (P0. 024), 12 patients with multilevel cervical Spondylotic myelopathy and 1 with ossification of posterior longitudinal ligament of cervical spine. One case of spontaneous epidural hemorrhage in cervical spinal canal was excellent in 9 cases (75%), good in 4 cases (50-75%), and fair in 1 case (50%). There was a significant difference in JOA score between preoperative, postoperative 2 weeks and postoperative 6 months (P < 0.001). There was no significant difference in JOA score between the two groups (P0. 087), but there was a significant difference between the preoperative and postoperative 6 months JOA scores (P0. 001). There were no complications of nerve root, vertebral artery, spinal cord injury or aggravated injury in all cases. Conclusion: cervical lateral mass screw fixation has the advantages of good mechanical strength, wide indication, safe operation and so on. It is a safe and reliable internal fixation method in posterior cervical surgery.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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