多轴螺钉-棒系统在颈椎后路固定中的应用与疗效

Application of Polyaxial Screw-rod System in Posterior Cervical Fixation and Its Outcomes

目的探讨多轴螺钉-棒系统行颈椎后路固定的疗效。方法本组18例,颈椎及椎管肿瘤9例,多节段脊髓型颈椎病并不稳2例,高危颈椎并外伤性颈髓损伤不稳3例,下颈椎骨折脱位4例。17例有不同程度的脊髓损害表现,JOA评分平均为9.8分。12例采用后路固定,6例采用前后联合手术。椎弓根固定2例,侧块固定11例,椎弓根与侧块混合固定5例。结果本组共植入102枚多轴螺钉,2枚螺钉位置欠佳,1例根性神经痛。本组无硬膜撕裂、椎动脉损伤与脊髓损伤等并发症。16例获得平均22个月的随访。X线片显示所有患者固定满意,无螺钉拔出、内固定松动、复位丢失。均获得坚固融合。神经功能均有不同程度恢复,改善率为69.4%。结论多轴螺钉-棒系统后路固定颈椎安全可靠,能取得满意的临床疗效。

Objective To explore the outcomes of cervical fixation using polyaxial screw- rod system. Methods Eighteen patients comprised nine with cervical or spinal canal tumor, two with cervical spondylotic myelopathy and instability, three with traumatic cervical spinal cord and cervical spondylosis or spinal canal stenosis, and four with lower cervical fracture and dislocation. Seventeen had neural defiets in different degrees. JOA score of the neural function was 9.8. Posterior cervical approach was used in twelve patients while the combined approach in six patients. Two patients were treated with pedicle fixation, eleven with lateral mass fixation and combined fixation in five. Results A total of 102 screws were implanted. Two screws were in malposition. One patient had radicular neuralgia. No eerebrospinal fluid leakage, spinal cord or vertebral artery injury occurred. Sixteen patients were followed up with for 22 months on average. All patients had satisfactory fixation and got firm fusion. No back- out of screw, loosing of fixation, and loss of reduction occurred. All had neurological recovery and the improvement rate was 69.4%. Conclusion The data indicate that posterior cervical fixation using polyaxial screw- rod system is safe and reliable with the satisfactory clinical outcome.