颈椎椎弓根螺钉徒手植入技术的临床研究

A Technique of Pedicle Screw Placement in Lower Cervical Spine

目的评价颈椎椎弓根螺钉徒手植入技术(无须术中影像技术引导)的安全性和可靠性。方法应用Axis内固定系统(美国枢法模公司)对36例颈椎疾病患者进行颈后路经椎弓根内固定术,共植入螺钉144枚,方法如下:①术中清晰地显露颈椎侧块和突间关节,用直径3.0mm高速球形磨钻去除侧块外上象限处骨皮质,然后用2.0mm的自制手锥沿椎弓根事先确定的方向轻轻钻入,若遇阻力则需略改变方向,使其自然置入,深约2～2.5cm。确定无误后,则安置Axis钛板和置入长度合适的椎弓根螺钉。②安装完毕后,即用C型臂X线机作双斜位透视,无误后关闭切口。结果从C3～C7,共植入根弓根螺钉144枚,其中10枚(6.8%)钉初次置入后感觉松动,经校正后二次置入成功,11枚(3.5%)钉道钻孔后出血较多,但及时处理后出血停止并无不良结果。术后X线斜位片及CT片显示,16枚(11.1%)螺钉穿破椎弓根,其中10枚螺钉(6.9%)穿破椎弓根外侧皮质,4枚(2.8%)穿破椎弓根上侧皮质,2枚(1.3%)穿破椎弓根下侧皮质。随访未发现与螺钉置入穿破椎弓根皮质有关的神经血管损伤问题。结论本研究提示,在事先充分的对每个患者颈椎椎弓根X线及CT解剖结构了解的情况下,徒手置入椎弓根螺钉行颈椎后路内固定安全可行。

Objective To report a method of pedicle screw placement without any intraoperative imaging monitors in lower cervical spine, and evaluate its safety. Methods Thirty-six patients were treated by cervical reconstruction with posterior plating and pedicle screw fixation, and followed up for at least two years. The pedicle screw position was evaluated by postoperative oblique radiographs and axial computerized tomography. Results A total of 144 screws were inserted into the cervical pedicles in 36 patients. The screw diameters used in the lower cervical spine were 3.5 and 4.0 mm, respectively. Postoperative imaging studies showed that 16 （11.1% ） screws violated the pedicle walls. Among them, 10 （6.9%） screws violated the lateral wall of the pedicle, 4 （2.8%） violated the superior wall, and 2 （1.3 % ） violated the inferior wall. However, there were no any neurological or vascular complications in 2-year follow-up. Conclusion Cervical pedicle screw insertion without intraoperative imaging guidance is safe and reliable, basing on 144 screw placements. The master of anatomy of the cervical pedicle and adjacent neurovascular structures, the careful preoperative review and experiences in pedicle screw insertion are mandatory for successful screw placement in the cervical spine.