摘要
目的总结颈椎侧块螺钉固定技术在颈椎后路手术中应用的临床经验。方法 2001年9月～2006年11月收治颈椎创伤与疾病患者8例,男6例,女2例;年龄28～78岁。创伤6例,棘突和椎板均有不同程度损伤;颈椎管狭窄及脊髓神经纤维瘤各1例。合并关节突绞锁2例,不全瘫痪者5例。肌力3～4级。6例创伤患者神经功能评价采用Frankel评分,术前C级2例,D级3例,E级1例。螺钉植入采用Margel方法,共植入螺钉40枚,其中C24枚,C36枚,C412枚,C54枚,C66枚,C72枚,T16枚。结果术后8例获随访6～45个月,平均14.1个月;X线片示骨折脱位复位良好,螺钉位置正常。1例术后3个月出现骨折节段颈椎不稳定,患者术前为关节突绞锁,复位后仅在远近端各固定1个节段的侧块;发现不稳定后立即行头颈胸支具固定3个月,颈椎骨性融合,稳定性恢复,继续随访至45个月,未见颈椎不稳定,已恢复伤前工作。余患者后期恢复良好,固定节段稳定,融合节段无假关节形成。神经功能均有不同程度的恢复,E级1例无变化;D级3例均恢复至E级;C级2例中1例恢复至D级,1例恢复至E级。全部患者可下地行走。结论颈椎侧块螺钉固系统能提供颈椎稳定的固定。
Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years, Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. The Frankel grading system was used in 6 patients with traumatic injury. Before operation, Grade C was observed in 2 patients,Grade D in 3,and Grade E in 1. All the operations were performed according to requirements of the Margel＇s method. We positioned 40 screws in all the patients, including 4 screws at C2, 6 screws at C3, 12 screws at C4, 4 screws at C5, 4 screws at C6, 2 screws at C7,and 6 screws at T1. Results The following-up for an average of 14. 1 months （range,6-45 months） revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The head-chest brace was applied to the patient for 3 months, and the spinal fusion was achieved. The further following-up to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion, The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and strong segmental immobilization for the good cervical spine stability.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2007年第10期1071-1073,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
颈椎
侧块
钢板螺钉
内固定
Cervical vertebra Lateral mass Plate and screw Internal fixation
