枢椎椎板螺钉在上颈椎后路固定术中的应用

Application of axis laminar screw in upper cervical vertebrae posterior fixation

目的探讨枢椎椎板螺钉固定术应用于上颈椎后路融合内固定术中的可行性。方法回顾性分析本院2012年1月一2014年12月在上颈椎后路融合固定术中采用枢椎椎板螺钉固定的19例患者资料，术中根据枢椎椎弓根是否存在缺如、细小等情况，选择置入双侧枢椎椎板螺钉或单侧枢椎椎板螺钉并对侧椎弓根螺钉，联合枕骨板螺钉和/或寰椎侧块螺钉。15例上颈椎畸形患者均有不同程度脊髓功能损害表现，日本骨科学会（JOA)评分为厂15分，平均11.5分。4例外伤性寰枢椎骨折患者有后颈部疼痛及活动障碍，疼痛视觉模拟量表（VAS)评分为2^7分，平均4.5分。术后复查患者影像学资料，观察内固定位置及植骨融合情况。结果所有手术顺利完成，未发生椎动脉、脊髓等损伤。术后复查CT，显示所有枢椎椎板螺钉位置良好，均未突破内侧皮质骨。随访时X线、CT示螺钉位置良好，无松动及断钉。所有患者术后12个月植骨均融合，上颈椎畸形患者神经功能均有不同程度改善，J0A评分为13—17分，平均15.3分。外伤性寰枢椎骨折患者颈部疼痛及活动障碍明显改善，VAS评分为0~2分，平均1.0分。结论枢椎椎板螺钉固定在上颈椎后路固定手术中方法简单安全、效果良好，对于无法行枢椎椎弓根螺钉固定的患者，枢椎椎板螺钉固定是一种安全有效的替代方法。

Objective To explore the feasibility of application of axis lam inar screw fixation in upper cervical spine fixation surgery via posterior approach. Methods The data of 19 patients underwent upper cervical spine fixation via posterior approach using axislaminar screws during January 2012 to December 2014. b lateral axis lam inar screws or un lateral axis lam inar screw and contralateralvertebral ped icle screw, combined with occipital plate screw and/or atlas mass screw were used for bone grafting via the posteriorcervical approach based on abscence or existence and size of the axial pedicle. Fifteen patients with upper cervical spine defoim ityhad varying degrees of sp inal cord function dam age, and the Japanese Orthopaed ic Association (JOA) score was 5-15, mean 11.5.Four traumatic atlantoaxial fracture patients had neck pain and dysfunction, and the visual analogue scale (VAS) score was 2-7,mean 4.5. Postoperative imaging data were reviewed to assess the internal fixation and bone graft fusion. Results All surgeries werecompleted successfully without spinal cord and vertebral artery injury. The postoperative CT scan showed all the axis lam inar screwshad been placed properly and did not break through dorsal or ventral cortical bone. There was no ins tab ilily,migration, loosening andbreakage of screws during the follow-up in all patients. A t postoperative 12 months, the intervertebral body bone graft had fused; Theneurological function of patients with cervical sp ine deformity was m proved to different degrees, and JO A score was 13 - 17, mean15.3; Neck pain and dysfunction of patients w ith traumatic atlantoaxial fracture were m proved, and VAS score was 0-2, mean 1.0.Conclusion In posterior upper cervical fixation, axis laminar screw fixation is simple and safe w ith goodoutcome. For patients who can not recive atlantoaxial transarticular screw fixation, axis laminar screw fixation is a safe and effective alternative method.