区域法下颈椎椎弓根钉植入技术的临床应用

Clinical application of cervical pedicle screw implantation technique under regional method

目的探讨区域法下颈椎椎弓根钉植入技术的临床应用效果。方法回顾分析2010年4月—2018年5月收治且符合选择标准的85例患者临床资料。男57例,女28例;年龄35~68岁,平均57.6岁。其中后纵韧带骨化10例,颈椎多节段退变椎管狭窄68例,颈椎肿瘤3例,先天发育畸形1例,颈椎外伤3例。病变部位累及C3~C7。术前Frankel脊髓损伤分级:C级2例,D级51例,E级32例。术中采用区域法下颈椎椎弓根钉植入技术,共植入618枚椎弓根钉。术后观察患者神经症状变化;行颈椎张口正侧位X线片及颈椎CT检查,评价椎弓根钉位置等级。结果手术时间2.5~4.0 h,平均3.0 h;术中出血量180~550 mL,平均345 mL。术中未出现血管、神经损伤,术前有神经症状患者术后均有不同程度好转。术后2例切口浅表感染,给予加强换药处理后切口愈合。术后住院时间5~14 d,平均8.4 d。出院时Frankel神经功能分级为D级26例、E级59例。85例患者均获随访,随访时间6~24个月,平均13个月。末次随访时颈椎X线片示椎弓根钉固定良好,无松动。颈椎CT评价椎弓根钉位置:Ⅰ级523枚(84.7%),Ⅱ级80枚(12.9%),Ⅲ级15枚(2.4%);植钉准确率97.6%。结论区域法下颈椎椎弓根钉植入技术充分考虑到个体差异,可明显提高植钉成功率,操作简便,术中不破坏骨皮质且固定牢靠。

Objective To investigate the effectiveness of cervical pedicle screw implantation technique under regional method.Methods The clinical data of 85 patients who met the selection criteria between April 2010 and May2018 were retrospectively analyzed.There were 57 males and 28 females,aged 35-68 years,with an average of 57.6 years.Among them,there were 10 cases of ossification of posterior longitudinal ligament,68 cases of cervical spondylosis with multilevel stenosis,3 cases of cervical tumor,1 case of congenital malformation,and 3 cases of cervical trauma;the lower cervical spine lesions involved C3-C7.Preoperative Frankel spinal cord injury grading:2 cases of grade C,51 cases of grade D,and 32 cases of grade E.Cervical pedicle screw implantation technique under regional method was performed with a total of 618 pedicle screws.Postoperative changes in neurological symptoms were observed;cervical mouth opening anteroposterior and lateral X-ray films and cervical CT examinations were performed to evaluate the pedicle screws position.Results The operation time was 2.5-4.0 hours,with an average of 3.0 hours.The intraoperative blood loss was 180-550 mL,with an average of 345 mL.No intraoperative vascular or nerve injury occurred.The patients with neurological symptoms were relieved to varying degrees.There were 2 cases of superficial incision infection after operation,the wound healed after enhanced dressing change.The postoperative hospital stay was 5-14 days,with an average of 8.4 days.At discharge,Frankel neurological grading was grade D in 26 patients and grade E in 59 patients.All the patients were followed up 6-24 months,with an average of 13 months.At last follow-up,cervical X-ray films showed the good pedicle screw fixation without loosening.Cervical CT evaluated the position of pedicle screws:523 pedicle screws(84.7%)in gradeⅠ,80(12.9%)in gradeⅡ,and 15(2.4%)in gradeⅢ;the accuracy rate of the screw position was 97.6%.Conclusion Cervical pedicle screw implantation technique under regional method can significantly improve the success rate of screw implantation.It is easy to operate,does not destroy the bone cortex,and has stable fixation.