下颈椎内固定治疗进展及问题探讨

Treatment with internal fixation in lower cervical spine

本文介绍了下颈椎前路和后路使用各种器械进行内固定的最新方法,并对其中常见的一些问题进行了探讨。颈椎前路钢板螺钉内固定系统可以明显提高植骨融合率,其并发症以内固定松动或失败最为常见,简要介绍了预防该并发症在操作时需注意的各种事项及方法。颈椎前路界面固定技术可以无须另外取自体髂骨或腓骨等进行植骨,避免了二次手术的并发症。人工椎间盘置换术可以避免融合后相邻节段的继发退变以及由此引起的新症状,最终疗效还需要大宗病例积累和长期随访结果证实。颈椎侧块螺钉内固定操作方法较多,但比较简单,固定可靠。对神经根、脊髓的损伤是其最重要的并发症,熟悉颈椎解剖可以避免这些并发症。颈椎椎弓根内固定技术是目前固定最为牢固的方法,操作比较困难,主要并发症是螺钉穿破椎弓根,术前仔细的影像学研究或使用导航技术,做到个体化置钉,可以有效提高置钉准确率。

This article introduced some new internal fixation techniques used in lower cervical spine through anterior and posterior approach, and some common problems in the application of these techniques were discussed. Fusion rate was obviously improved in the use of anterior screw-plate system. Loosening or failure of the plate was its common complication, and methods of prevent ention of these complications were introduced. The interface fixation technique avoided the second incision for iliac crest or fibula and the occurrence of complications. Artifical disc replacement may preserve the inter veterbral movement and decreased degeneration of the adjacent segments ,the advantage of the cervical disc prosthesis needed to be confirmed with large member of patients and lone-term follow-up. There were many methods of internal fixation with lateral mass screws ,which were simple and reliant. Its important complication was the injury of nerve roots and spine cord. Familiar with the anatomy of local cervical spine may decrease such complications. Pedicle screws can provide the strongest fixation in cervical spine, but its man- pulation was difficult. Pedicle screw penetrating the cortex of the vertebrae was its main complication. Preoperative careful study of radiograph or using navigation technique ,and inserting screws individually can decrease this complication.