Vertex内固定系统治疗寰枢椎不稳:临床效果与植入物特征的关系

Vertex technique for treatment of atlantoaxial instability:Clinical outcomes and implant features

文章探讨了Vertex内固定系统植入治疗寰枢椎不稳定的临床效果与植入物材料学性能的相关性。选择2004-01/2006-01泸州医学院附属医院收治的寰枢椎脱位与不稳26例患者,采用美国美敦力·枢法模·丹历公司生产的Vertex颈椎后路钉棒内固定系统进行手术。对26例寰枢椎脱位患者采用Vertex内固定及寰枢椎融合术,摄动力位X射线片及CT检查寰枢椎稳定程度,记录每一例患者的术中并发症,术后功能恢复及融合情况。结果:①22例患者术后3个月X射线片显示寰枢融合成功,3例患者术后6个月X射线片显示寰枢融合成功,1例患者1年后植骨吸收再手术植骨,在术后3个月融合成功。②无脊髓损伤加重等并发症,术前JOA17分法评定脊髓功能3～17分,平均6.8分,术后为5～17分,平均14.8分,改善率83%。③26例患者颈部伸屈运动正常,旋转功能均有部分丢失,18例患者旋转达120°,6例患者旋转达100°,1例患者旋转达60°。Vertex内固定系统是颈椎后路钉棒内固定系统,因其具有万向螺钉和随意塑行的棒相连接,做到了固定可靠,节段长短随意和钉棒连接方便的临床应用优点。Vertex内固定系统治疗寰枢椎脱位术后效果亦比较理想。

This paper is aimed to explore the correlation of clinical outcomes with material science features of implant in the treatment of atiantoaxial instability by the Vertex technique. A total of 26 cases with aUantoaxial instability and dislocation were enrolled from the Affiliated Hospital of Luzhou Medical College between January 2004 and January 2006. They all underwent the internal fixation via posterior cervical pathway and aUantoaxial fusion in Vertex system that was produced by American Sofamor Danek Company. The intraoperative complications and postoperative neurological recovery of each case ware documented. Dynamic radiograph and digital tomography ware used to evaluate the extent of the atlantoaxial vertebrae stability. ① The result of X-rey showed that bony fusion was successful in 22 patients during 3-month follow-ups, 3 patients during 6-month follow-ups, and 1 case after implantation following bony resorption. ② There was no deterioration of spinal cord injury and the JOA scores of neurofunction increased from 3-17 points （mean 6.8 points） to 5-17 points （mean 14.8 points）, with the rate of improvement as 83%.③All 26 patients ware nOrmal in the movements of expansion and flexion, but the rotation was partly limited. There ware 18 cases rotate in 120°, 6 cases in 100° and 1 case in 60°. Vertex system is effective in dealing with internal fixation via posterior cervical pathway. Due to the connection with stick by multiaxial screw, Vertex system presents superiority in clinic, such as secure fixation, random length and convenient connection.Vertex system internal fixation is effective in dealing with attantoaxial instability and dislocation.