颈椎后路经关节螺钉钢板内固定术在下颈椎骨折脱位中的应用

Posterior plating and transarticular screws for treatment of fracture and dislocation of the lower cervical spine

目的 探讨后路经关节螺钉钢板固定在下颈椎骨折脱位中的临床应用。方法2003年2月-2006年5月，对22例严重下颈椎骨折脱位采用后路经关节螺钉Axis钢板固定10例；后路联合前路减压、植骨融合、Orion钢板固定12例，共置入78枚经关节螺钉。术中运用Klekamp经关节螺钉技术，以侧块中心点内侧1mm为进钉点，进钉角度在矢状面上尾倾40°，在冠状面上外倾20°，行四层皮质固定。结果 22例患者均获得随访，时间3个月～3年，平均15个月。术中所有螺钉均成功置入，1例患者术后第3天出现C7单侧神经根刺激症状，未予特殊处理，3个月后症状消失。没有出现椎动脉和脊髓损伤等其他置钉相关并发症。发现1例螺钉松动部分脱出，经加强颈托制动，术后3．5个月仍获得融合。其余患者均融合成功。结论 下颈椎后路经关节螺钉钢板固定如使用得当，固定可靠、操作简单、相对安全。经关节螺钉钢板置入前，必须行脱位复位和小关节间植骨。

Objective To evaluate clinical application of posterior plating and transarticular screws in treatment of fracture and dislocation of the lower cervical spine. Methods From January 2003 to May 2006, 22 cases with lower cervical spine injury were treated with posterior AXIS plating and transarticular screws （ 10 cases） and combined anterior decompression, bone graft and anterior plating fixation （12 cases）, with a total of 78 screws used. By using Klekamp transarticular screw technique, the starting point for screw insertion was located 1 mm to the midpoint of the lateral mass, with insertion angle of 40° caudally in the sagittal plane and 20° laterally in the coronal plane. Muhicortical （four-layer） fixation was performed. Results The follow-up period ranged from 3 months to 3 years （ mean 15 months）. Transarticular screw insertion was successful in all cases. One case of nerve root irritation recovered after three months without special treatment. There were no other complications related to screw insertion, such as vertebral artery injury or spine cord injury. Only one case with screw partial backout was identified but got fusion after 3.5 months. Conclusions Posterior plating and transarticular screws in the lower cervical spine is an efficient and reliable technique, for it has the advantages of strong stability, relatively simple and safe operation. Reduction and graft must be completed before placement of the screws and plates.