椎弓根螺钉技术在下颈椎不稳中的安全使用方法

Clinical application of cervical pedicle screw system in lower cervical spinal disorder

目的 探讨颈椎椎弓根技术在下颈椎疾病的安全使用方法。方法 回顾性分析2001年10月-2006年3月76例下颈椎疾病行颈椎椎弓根固定患者，其中49例为颈椎骨折脱位，23例为颈椎病，4例为椎管内肿瘤。患者术前均行X线和CT等检查，术中在C形臂X线监视下置钉，术后行X线和CT检查了解螺钉位置。结果 76例螺钉均成功置入，术中无脊髓、椎动脉损伤。术后CT显示，342枚螺钉中有37枚（10．8％）螺钉穿破椎弓根，其中29枚螺钉穿破椎弓根外侧皮质，3枚螺钉穿破椎弓根上侧皮质，5枚螺钉穿破椎弓根下侧皮质。所有患者近期及远期随访未发现与椎弓根螺钉相关的神经血管及内脏器官损伤的并发症。有1枚螺钉断裂，但患者没有明显的临床症状，其余未发现螺钉松动或断钉及颈椎不稳症等。所有患者固定良好，并均已达骨性融合。术后随访脊髓神经功能均有不同程度改善。结论 颈椎椎弓根固定提供了三柱的稳定和最坚强的后方固定，为了防止并发症的发生，熟悉颈椎椎弓根的解剖和手术操作技巧以及采用个体化综合置钉是决定手术成功的重要因素。

Objective To apply cervical pedicle screw system to treat cervical disorders and discuss its surgical indications and safety. Methods A total of 76 cases （ 51 males and 25 females, with age range of 18-78 years） with middle and lower cervical spine lesions who underwent cervical transpedicular fixation from October 2001 to March 2006 were analyzed retrospectively. There were 42 cases with fractures and dislocations of cervical spine accompanied by complete paralysis （ 15 cases） or incomplete paralysis （27 cases） , 23 with cervical spondylotic myelopathy and four with spinal cord tumor, all of whom were diagnosed with anteroposterior and lateral radiographs and CT scanning through bone windows and/or MRI prior to surgery. During surgery, all screws were inserted into the pedicle under the guidance of lateral or oblique image intensifier to confirm the direction and insertion depth of screws. After surgery, the location of the screws was evaluated with radiographic examination and CT scanning. Results Screw placement was successful in all cases, without any neurologic or vascular complications related to pedicle screws. There were 37 screws （ 10.8% ） perforating the pedicle, with 29 perforating the lateral wall of the pedicle, three perforating the superior wall and five perforating the inferior wall, which was identified by postoperative CT scanning. There was one screw breakage, without serious clinical symptoms. There was no screw loosening or instability during follow-up, with fusion achieved in all cases. The function of the spinal cord in cases with severe lower cervical fracture and dislocations was improvement at different degrees after surgery. Conclusions Cervical pedicle screw fixation provides tricolumn stableness and the strongest posterior fixation. Familiarity with cervical anatomy, skillful manipulation and individuality of screw fixation are necessary for a successful surgery.