颈椎椎弓根钉棒系统内固定在下颈椎骨折脱位治疗中的临床应用

Clinical application of the cervical transpedicular screws in the treatment of lower cervical spine fractures-dislocation

目的探讨颈椎椎弓根钉内固定治疗下颈椎骨折脱位时的置钉方法、生物力学稳定性、适用范围、并发症、临床效果及影响因素。方法采用Axis系统经椎弓根内固定治疗颈椎骨折脱位76例。所有患者术前均行X线、CT及MRI检查,并根据测量结果对每一椎弓根钉实施个体化置入。定期复查,观察损伤节段的稳定性和融合率,采用美国脊柱损伤协会（ASIA）神经功能分级判定脊髓功能的恢复情况。结果 76例患者均获得随访,随访时间为12~48个月,平均14.8个月。所有随访患者骨折脱位复位均良好,损伤节段恢复稳定,颈椎椎体高度、生理曲度等均恢复正常,融合率高达100%,内固定置钉位置良好,无植骨块脱出、螺钉松动或断裂等并发症发生。治疗结束后,脊髓功能评价平均提高1.11级,6例患者术后神经症状无变化。结论颈椎椎弓根钉内固定提供了三柱的稳定性和最坚强的后方固定,是治疗颈椎骨折脱位安全有效的方法之一。合理选择手术适应证,熟悉颈椎解剖结构,术中规范操作以及置钉个体化等是手术成功的关键。

Objective To discuss the internal fixation for cervical fracture-dislocation with cervical pedicle screws about the screw positioning methods, biomechanical stability, application range and complications, clinical effects and influence factors. Method 76 patients with cervical fracture-dislocation were treated with transpedicular internal fixation therapy of Axis system. All patients underwent X line, CT and MRI examination before operation and according to the measurement results, each pedicle screw wat put into practice. The stability and the rate of fusion of the injured segments were observed through periodic check, the spinal function was evaluated with ASIA classification. Result 76 patients were followed up from 12 ~ 48 months, on the average of 14.8 months. In all followed patients, the injured segments were stable; the height and lordosis of cervical spine were well-maintained; the fusion rate was 100%, and internal fixation was well-located. There was no complication of bone grafting extrusion and plate or screws loosening or broken. The function of spinal cord was improved by 1.11 grade. No deterioration of nerves symptoms occurred in 6 patients after operation. Conclusion Cervical transpedicular screw internal fixation therapy is identified to be safe and effective for cervical fracture and dislocation, which provides stability of three-columns and the strongest posterior fixation.