下颈椎椎弓根内固定的解剖学研究与临床应用

Transpedicular Screw Fixation for the Lower Cervical Spine: Anatomical Study and Clinical Application

目的：为椎弓根螺钉在颈椎的应用提供解剖学基础，介绍手术方法和适应证。方法：用游标卡尺和Ｘ线摄片测量方法，对５４具成人颈椎干燥标本Ｃ３～Ｃ７椎弓根的高度、宽度、长度、进钉点定位及椎弓根轴线的角度等进行解剖学观测。结果：颈椎椎弓根可以接受螺钉内固定；进钉点定位在Ｃ３～Ｃ６位于关节突背面外上象限的中点，Ｃ７位于关节突中垂线接近上关节面的下缘；进钉方向平行于椎体的上终板，与矢状线的夹角在Ｃ３～Ｃ６为４０°～４５°，Ｃ７为３０°～４０°。应用椎弓根螺钉钢板治疗颈椎损伤、肿瘤１９例，无颈髓、神经根及椎动脉损伤等并发症。１８例获随访，平均随访１３个月，固定节段稳定，神经功能有不同程度恢复，临床疗效满意。结论：颈椎椎弓根内固定，固定坚强，手术后可以摆脱外固定，方便护理，利于病人早期锻炼和康复，是一种良好的重建颈椎稳定的内固定方法。

Objective: To provide an anatomic basis for the use of transpedicular screw fixation in lower cervical spine, and to describe the techniques and indications. Methods: The three dimensional quantitative anatomy of lower cervical pedicular was determined in 54 adult dry cervical specimens using vernier calibre and radiography, the parameter included the height, the width, the length, the axis angulation of the pedicle, the point of screw penetration and so on. Results: The pedicles of the lower cervical spine were wide enough to accept 3.0- 4.5 mm screws based on various levels. The entrance point of screw was determined at the central point of the upper lateral quadrant of articular mass from level C 3 to C 6, and it was at the middle vertical line of the articular mass and close to the superior facet joint at the level C 7. The angle of the screw in the sagittal plane was 40 to 45 degrees from level C 3 to C 6, and 30 to 40 degrees at the level C 7,and parallel to the upper end plate. Nineteen patients with 17 cervical spinal cord injuries and 2 metastatic cervical spinal tumours were treated by transpedicular screw fixation. There was no complication involving the vertebral artery, spinal cord, or nerve root. Eighteen cases were followed up for an average of 13 months. The stability of cervical spine and the neurological improvement were satisfactory. Conclusion: Transpedicular screw fixation for cervical spine has the stiff internal stabilizing effect, and no need of postoperative external support. The postoperative nursing care was easy. The patients were allowed early ambulation and rehabilitation. It is one of the most useful procedures for reconstruction of the cervical spine.