本文選題：樞椎 + 骨螺絲　； 參考：《脊柱外科雜志》2016年06期

【摘要】：目的探討樞椎椎板螺釘固定術(shù)應(yīng)用于上頸椎后路融合內(nèi)固定術(shù)中的可行性。方法回顧性分析本院2012年1月—2014年12月在上頸椎后路融合固定術(shù)中采用樞椎椎板螺釘固定的19例患者資料,術(shù)中根據(jù)樞椎椎弓根是否存在缺如、細(xì)小等情況,選擇置入雙側(cè)樞椎椎板螺釘或單側(cè)樞椎椎板螺釘并對(duì)側(cè)椎弓根螺釘,聯(lián)合枕骨板螺釘和/或寰椎側(cè)塊螺釘。15例上頸椎畸形患者均有不同程度脊髓功能損害表現(xiàn),日本骨科學(xué)會(huì)(JOA)評(píng)分為5~15分,平均11.5分。4例外傷性寰樞椎骨折患者有后頸部疼痛及活動(dòng)障礙,疼痛視覺(jué)模擬量表(VAS)評(píng)分為2~7分,平均4.5分。術(shù)后復(fù)查患者影像學(xué)資料,觀察內(nèi)固定位置及植骨融合情況。結(jié)果所有手術(shù)順利完成,未發(fā)生椎動(dòng)脈、脊髓等損傷。術(shù)后復(fù)查CT,顯示所有樞椎椎板螺釘位置良好,均未突破內(nèi)側(cè)皮質(zhì)骨。隨訪時(shí)X線、CT示螺釘位置良好,無(wú)松動(dòng)及斷釘。所有患者術(shù)后12個(gè)月植骨均融合,上頸椎畸形患者神經(jīng)功能均有不同程度改善,JOA評(píng)分為13~17分,平均15.3分。外傷性寰樞椎骨折患者頸部疼痛及活動(dòng)障礙明顯改善,VAS評(píng)分為0~2分,平均1.0分。結(jié)論樞椎椎板螺釘固定在上頸椎后路固定手術(shù)中方法簡(jiǎn)單安全、效果良好,對(duì)于無(wú)法行樞椎椎弓根螺釘固定的患者,樞椎椎板螺釘固定是一種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.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院骨科;
【分類號(hào)】：R687.32

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本文編號(hào)：1734309