寰椎侧块螺钉与枢椎弓根螺钉徒手植入技术的研究与应用

Study and application of free hand insertion with the lateral mass screw of atlas and vertebra dentata pedicle screw

[目的]探讨徒手植入寰椎侧块螺钉与枢椎椎弓根螺钉方法，总结临床应用效果。[方法]新鲜成人寰枢椎标本各50具，男女各25具，用尖嘴咬骨钳咬除进钉点骨皮质，先后分别用1．5、2．5mm克氏针制备钉道，再用锤子将导锥顺着制造的钉道小心击人，待有落空感时停止；寰椎侧块螺钉进钉点选择在寰椎后结节中点旁开18～20mm，与后弓下缘以上2mm的交点，钉道方向在冠状面垂直，矢状面上螺钉头端向头侧倾斜约5°。枢椎进钉点为枢椎下关节突根部中点，钉道与矢状面夹角约15°，横断面夹角约30°。临床寰枢椎不稳患者26例，男15例，女11例，平均39．5岁；应用钉棒系统17例，钉板系统9例。术前JOA评分5．1～10．6分，平均7．5分。[结果]术后无1例发生脊髓和椎动脉损伤。随访9～32个月，平均15个月，JOA评分12．9～16．5分，平均14．5分，改善率87．6％。植骨块全部融合，无内固定断裂、松动。

[ Objective] To summary the methods and results of free hand insertion with the lateral mass screw of atlas and vertebra dentata pedicle screw. [ Method] Fifty samples of fresh adult atlas and dentate were used. There were 25 males and 25 females samlpes. Then rongeur forceps was used to bite the bone of entrance. The way of screw was made by Kirschner wire of 1. 5mm and 2.5mm in diameter. Guide pin was inserted along the way. The screws were placed in lateral mass of atlas beside the posterior arch of atlas about 18 -20mm and the point of intersection above 2mm inferior boarder of posterior arch. Vertical with coronal plane, the tip of the screw was made 5° to side of head in sagittal plane. The site of the screws placed in vertebra dentate was divided equally the inferior articular process of axis ,made 15°with sagittal plane and 30°with cross section. There were 26 patients with Atlantoaxial vertebra unsteadiness, 15 males and 11 females,with an average age of 39.5 years. Seventeen cases were used with screws and rod system and 9 patients were used screws and plate system. Preoperative JOA scores were from 5.1 to 10.6,with an average of 7.6. [ Result]There were no cases with spinal cord and vertebral artery injury after surgery. Follow-up duration was from 10 to 25 months,with an average of 14 months. The postoperative JOA scores were from 12.9 to 16.5 ,with an average of 14.8. The improve rate was 87.6 percent. The plant bones all fused and there were no internal fixation rupture and mobiled. [ Conclusionl The technique of free hand insertion with the lateral mass screw of atlas and vertebra dentata pedicle screw is simple, fixation is reliability and is well worth to spreading.