上颈椎骨折脱位侧块钛板椎弓根螺钉内固定置入与宿主的生物相容性

Biocompatibility between titanium plate pedicle screw internal fixation on cervical lateral mass and hosts in treating upper cervical fracture dislocation

目的:探讨上颈椎骨折脱位颈椎侧块钛板椎弓根螺钉内固定置入后的疗效及生物相容性特点。方法:应用计算机检索Medline database(1991/2006)、中国期刊全文数据库(CNKI:1991/2006),由作者对文献进行筛选、资料收集和质量评价,总结颈椎侧块钛板椎弓根螺钉内固定置入治疗上颈椎骨折脱位的疗效及生物相容性特点。并选择2003-01/2008-01右江民族医学院附属医院脊柱骨病外科收治上颈椎骨折脱位19例进行临床验证,车祸伤10例,高处坠落伤6例,重物砸伤3例。颈椎损伤节段:C18例,C211例,病程3h^10d。其中16例合并脊髓神经根损伤,Frankle分级,A级4例,B级3例,C级4例,D级2例,E级3例(合并神经根损伤伴有手、肩麻木),均行小关节植骨融合、侧块钛板内固定置入治疗;置入后摄X射线片观察植骨融合、颈椎活动及内固定稳定情况,并按Frankle分级法评定神经功能恢复情况。结果:纳入的21篇文章结果显示,采用侧块钛板椎弓根螺钉内固定置入治疗不稳定性的上颈椎骨折脱位,是上颈椎骨折脱位手术方法中稳定上颈部最为符合生物力学方式的骨折-固定方法。临床验证结果显示,X射线片可见颈椎侧块间隙,后弓与椎板间隙植骨融合,时间为3~6个月。术后6个月X射线片显示内固定牢固稳定,无折断松动等并发症。16例脊髓神经根损伤者中,按Frankel分级,术前A级4例中,术后3例为B级,1例为C级;术前B级3例中,术后为C级2例,D级1例;术前C级4例中,术后D级3例,E级1例;术前D级2例中,术后均为E级;3例E级术后无变化,3例合并神经根损伤,术后短期内手、肩麻木消失。与人体组织的生物相容性好,术后2年随访,无血液、免疫、组织等反应,无囊膜形成及细胞质的转变;亦无钛合金腐蚀、磨损等材料反应的发生。结论:颈椎侧块钛板椎弓根螺钉后路短节段固定保留了枕寰和C2~3的关节功能,最大限度地保留上颈椎的运动功能单位,钛板椎弓根螺钉固定在颈椎后部的关节柱上,对过伸过屈损伤有良好的稳定作用,与人体组织的生物相容性好,无血液、免疫、组织等反应及腐蚀、磨损等材料反应发生。

OBJECTIVE： To evaluate characteristic of biocompatibility of the titanium plate pedicle screw internal fixation in treatment of the upper cervical fracture dislocation. METHODS： An on line search of Medline and CNKI database was undertaken between 1991 and 2006 to identify article regarding patients with the upper cervical fracture dislocation who were treated with the titanium plate pedicle screw internal fixation. All the documents were screened, collected and evaluated. Nineteen patients with the upper cervical fracture dislocation admitted in the Department of Orthopaedics, the Affiliated Hospital of Youjiang Medical College for Nationalities From January 2003 to January 2008, were collected and undertaken clinical validation. 10 patients were caused by a road accident, 6 by a high crash, and 3 by a heavy object crash. The fracture dislocation occurred in the following cervical segments： C1 （8 patients）, C2 （11 patients）. The disease course ranged from 3 hours to 10 days. The associated spinal nerve root injury occurred in 16 patients. The Frankle scaling revealed that 4 patients were at Grade A, 3 at Grade B, 4 at Grade C, 2 at Grade D, and 3 at Grade E （associated nerve root injury with hand and shoulder numbness）. The 19 patients underwent the grafting fusion of the small joints, and the lateral mass titanium pedicle screw internal fixation; the bone fusion, cervical vertebra movement, and internal fixation condition were observed by the X-ray examinations postoperatively. The nerve function recovery was evaluated by the Frankle scaling system, RESULTS： The 21 articles included in the results showed that inserted lateral mass titanium plate pedicle screw and treated unstable upper cervical spine with fracture and dislocation was the most fracture-fixation methods in line with the neck of the biomechanics approach. The clinical verification revealed that the small joint fusion time was 3-6 months. The cervical X-ray films showed that there was no instability or fracture looseness of the internal fixation at 6 months. Among the 16 patients with the spinal nerve root injury, 4 were at Grade A preoperatively but 3 were improved at Grade B and 1 at Grade C postoperatively; 3 were at Grade B preoperatively but 2 were improved at Grade C and 1 at Grade D postoperatively; 4 were at Grade C preoperatively but 3 were improved at Grade D and 1 at Grade E postoperatively; 2 at Grade D preoperatively but all the 2 were improved at Grade E postoperatively; 3 were at Grade E preoperatively and remained unchanged postoperatively. In the 3 patients with only the nerve root injury, numbness disappeared soon after operation. The result also demonstrated that the titanium plate pedicle screw and biocompatibility with human tissue, and after 2-year follow-up, no blood, immune, response organizations, non-capsule formation and changes in the cytoplasm; or titanium alloy corrosion, wear and tear, such as the occurrence of material response. CONCLUSION： The cervical lateral mass titanium plate pedicle screw fixation of posterior short segment retains the atlanto-occipital and the C2-3 joint function, maximizes the retention of the motor function of upper cervical units. Titanium plate pedicle screw fixation in the cervical posterior column joints have a good stability in hyperextension injury and over-flex injury, biocompatibility with human tissue, and no blood, immune, and organizational response and corrosion, wear and other material reaction.