三叠转盘卡在颈椎椎弓根内固定术中的临床应用

Three Fold Rotary Card in Cervical Pedicle Companion in the Clinical Application

目的探讨自创三叠转盘卡在颈椎骨折脱位椎弓根内固定术的临床应用效果。方法 2007年1月至2012年12月,基于国人颈椎解剖生理及影像学数据,自创三叠转盘卡。采用转盘卡定位对66例颈椎骨折脱位伴2节段以上脊髓损伤的患者实行颈椎侧块螺钉联合椎弓根螺钉治疗,其中男40例,女26例;年龄19～77岁,平均45岁。均行颈椎CT、MRI检查,颈髓损伤2节段36例,颈髓损伤2节段以上30例。损伤类型:32例一侧关节突骨折伴脱位,16例双侧关节突骨折伴脱位,18例椎板骨折脱位。脊髓功能评价:依据Frankel分级标准,A级19例,B级16例,C级16例,D级15例;入院平均JOA评分5.92分。结果术后随访3～24个月,平均13.5个月。术后颈椎完全复位65例,复位不完全1例。依据术前、术后JOA评分结果,术后改善率平均为62%;术后Frankel分级平均提高1级以上;椎弓根螺钉植入准确度为97.2%。结论颈椎椎弓根三叠转盘卡,在术中应用准确、安全、便捷,置钉准确率高,有利于患者脊髓神经功能的恢复,对颈椎椎弓根螺钉的置钉有较好的指导作用,为临床治疗提供了一种实用工具。

Objective To evaluate clinical application of a three-fold rotary dial in treatment of fracture and dislocation of cervical spine with pedicle screw fixation. Methods From January 2007 to December 2012, the three-fold rotary dial based on the anatomy and iconography data of Chinese people＇s cervical spine was invented. Then using the dial to locate the entry point of cervical pedicle screw in 66 patients with cervical spine fracture and dislocation combined two or more than two Segments of spine cord injury, and all cases were treated by the method of pedicle screw fixation. Sixty-six patients ,40 males and 26 females,aged 19 -77 （mean 45 ）,underwent vertebral body compressive fracture and dislocation. All cases were examined by cervical CT and MRI. 36 cases were with two levels of spine cord injury, and 30 cases more than two. There were 32 cases with unilateral facet dislocation, 16 cases with bilateral facet dislocation, and 18 cases with lamina fracture and dislocation. The eval- uation of spinal cord function：According to Frankel grades, there were 19 cases of grade A, 16 cases of grade B, 16 cases of grade C and 15 cases of grade D. The JOA （Japanese Orthopedic Association） scores was 5.92 on an average. Results All patients were followed up for 12 to 36 months, the mean follow-up time was 13.5 months. The ideal anatomy reduction was a- chieved in 65 cases. Only one case could not completely obtain reduction. Based on the preoperative, postoperative JOA score results ： The improvement rate of JOA scores was 62%. Spinal cord lesions improved on average 1 Frankel grade at lest after surgery. The accuracy of screw insertion was 97.2%. Conclusion Using the three-fold rotary dial of cervical spine pedicle in operation is safe, simple, convenient. It is helpful to the spinal nerve function recovery in patients with the cervical spine. The dial can efficiently guide the insertion of cervical pedicle screw in clinic and improve the accuracy of screw insertion. It is an useful tool.