颈椎前路钛板置入内固定后螺钉松动3例

Three cases of screw loosening following anterior cervical plate fixation

背景:对于保守治疗效果不佳的颈椎病患者及颈椎外伤后椎间盘突出或椎体骨折压迫脊髓出现神经根神经症状者,颈椎前路椎间盘切除、椎体次全切植骨/钛笼固定仍然是其主要治疗方式。目的:总结颈前路钛板内固定后螺钉松动的原因及防治策略。方法:纳入41例颈椎病和颈椎损伤患者,根据手术适应证选择经前路颈椎间盘切除、椎体次全切行颈椎前路钛板内固定,内固定后有3例出现螺钉钛板松动,分析其发生原因并提出防治方法,以减少颈前路钛板螺钉松动的发生率。结果与结论:3例螺钉松动患者均出现不同程度的吞咽困难症状,确诊后2周内行2次手术,调整螺钉位置后重新固定钛板,远期观察患者内固定位置良好,症状缓解。提示适应证及置入方法的选择,内固定器材的合理应用,正确的置入后管理是预防颈前路钛板内固定后螺钉松动的关键。

BACKGROUND：Anterior cervical discectomy and subtotal vertebrectomy/titanium cage fixation are the main therapies for patients with poor outcomes of conservative treatment for cervical spondylosis or those with neurological symptoms of the nerve root following cervical injuries or vertebral fractures.OBJECTIVE：To conclude the reasons and preventive measures for screw loosening following anterior cervical plate fixation.METHODS：Among 41 cases of cervical spondylosis and cervical injuries undergoing anterior cervical fixation plate,there were 3 cases of screw loosening.The causes and control methods were analyzed and proposed to reduce the anterior plate incidence o screw loosening.RESULTS AND CONCLUSION：Three cases of screw loosening presented with varying degree of dysphasia.After diagnosed,second operation was performed within 2 weeks to adjust the position of re-fixed titanium screw,and the long-term observation showed patients with good symptom relief.The surgical indications and the choice of the rational application of internal fixation devices as well as the correct postoperative management is the key to prevent screw loosening.