颈椎侧块钢板固定术治疗下颈椎骨折脱位

Cervical lateral mass plate fixation for treatment of fracture and dislocation of the lower cervical spine

目的探讨颈椎侧块钢板固定术在下颈椎骨折脱位的临床应用。方法2001年2月-2003年6月,应用颈椎侧块钢板治疗下颈椎骨折脱位21例,根据骨折脱位情况进行术中减压、复位,选择颈椎侧块钢板螺钉技术,采用侧块中点内下1～2mm为进钉点,矢状面与关节面平行(45°),冠状面向外25°～30°。选取合适螺钉进行固定。结果21例均获随访6个月～2年9个月,平均13个月。术后在颈围保护下4～7d坐起,无脊髓损伤或C级以下脊髓损伤病例,离床活动时间4～14d,平均7d。术后4～6个月均获得良好骨性融合。16例脊髓损伤患者按美国脊柱脊髓损伤学会(ASIA)分级平均提高1级。3例神经根损伤术后神经功能完全恢复。术中无血管、神经系统损伤,1例复位不完全,2例(共2枚)螺钉松动。结论颈椎侧块钢板内固定术具有适应范围广、操作简单安全、固定牢固等优点,是颈后路固定的一种有效、可靠的方法。

Objective To evaluate the application of cervical lateral mass plate fixation in the treatment of fracture and dislocation of lower cervical spine. Methods From February 2001 to June 2003, 21 cases of lower cervical spine injury were treated by cervical lateral mass plating fixation, received spinal decompression and reduction according to the types of fracture and dislocation. A cervical lateral mass plate was applied in each lateral mass. The screw prick point was defined at 1-2 mm inner and lower to the mass center. The sagital angle, horizontal angle of internal fixation screw were 45 degrees and 25-30 degree respectively. Results The follow up ranged from nine months to two years and nine months （ mean 13 months）. All cases were encouraged to sit up, wearing soft collar 4-7 days after the surgery. The mean off-bed time of those cases without spinal cord injuries less than Frankel C grade were seven days （4-14 days） after operation. All cases obtained solid bony fusion 4-6 months postoperatively. Sixteen cases with spinal cord injury improved for one grade according to American Spinal Injury Association. Three cases with nerve root injury obtained complete recovery after operation. There was no severe complication such as vertebral artery nerve root or spinal cord injuries or aggravation of spinal cord injury. One case had uneven reduction and two suffered screw loosening. Conclusion Cervical lateral mass plate fixation is an efficient and reliable technique for segmental posterior fixation, for it has the advantages of wide indication, relatively simple and safe operating as well as strong stability.