徒手寰枢椎椎弓根螺钉置钉的临床应用体会

Clinical application experience of unarmed atlas vertebral pedicle screws

目的探讨徒手植入寰椎侧块螺钉与枢椎椎弓根螺钉方法,总结临床应用经验及效果。方法临床寰枢椎不稳患者16例,男11例,女5例,平均37.5岁;应用钉棒系统。后路正中切口显露寰椎后弓及枢椎椎板,寰椎侧块螺钉进钉点选择在寰椎后结节中点旁开18~20 mm,与后弓下缘以上2 mm的交点,钉道方向在冠状面垂直,矢状面上螺钉头端向头侧倾斜约5°。枢椎进钉点为枢椎下关节突根部中点,钉道与矢状面夹角约15°,横断面夹角约30°。术前JOA评分58~102分,平均72分。结果术后无1例发生脊髓和椎动脉损伤。随访7~22个月,平均15个月,JOA评分131~163分,平均145分,改善率86.4%。植骨块全部融合,无内固定断裂、松动。结论寰椎侧块螺钉与枢椎椎弓根螺钉徒手植入技术简单、可靠,值得推广。

【Objective】To explore unarmed implant atlas lateral mass screws and atlas vertebral pedicle screws and clinical application experience and effect.【Method】Clinical vertebral instability between atlas 16 cases of patients,male,female 11 cases in 5 cases,an average of 37.5 years;Application was great system.The center of the posterior incision atlas bow and hub after the presence of cervical board,atlas lateral mass screws into the nails point selection in the halfway point after atlas nodules open 18～20 mm,and inferior after more than 2 mm bow intersection of the way,nailing direction in the coronal vertical sagittal plane,head to head the screw side tilt about 5°.Atlas and nail into point as atlas of the joint to root the midpoint of nail,tao and sagittal Angle about 15°,about 30° cross-sectional Angle.Preoperative JOA scoring 58 to 102 points,an average of 72 points.【Results】No one case had spinal cord and vertebral artery injury.Follow-up was 7 ～22 months with an average of 15 months,JOA rating was 131～163 points,an average of 145 points,86.4% was improved.All bone graft was fused without inner fixed fracture and loose.【Conclusion】Atlas lateral mass screws and atlas vertebral pedicle screws unarmed implant technology is simple,reliable,worthy to be popularized.