枢椎棘突椎板螺钉固定技术的建立与初步临床应用

Establishment and preliminary clinical application of C2 spinous lamina screw fixation

目的:介绍枢椎棘突椎板螺钉固定技术,并评价其初步临床应用效果。方法:建立枢椎棘突椎板螺钉固定技术,并应用于2022年1—12月收治的5例寰枢椎脱位和颅底凹陷症患者。采用日本骨科协会(JOA)评分评估患者神经功能状态,测量寰齿前间隙(ADI)评估寰枢椎复位情况,测量脊髓有效空间(SAC)评估脊髓压迫情况。术后及随访期间行X线、CT检查评价寰枢椎序列、枢椎棘突椎板螺钉位置、整体内固定及植骨融合情况。结果:所有患者手术均顺利完成,1例行后路寰枢椎钉棒固定融合术,4例行后路枕颈钉棒固定融合术,平均手术时间(134.6±25.2)min,平均中出血量(150.0±50.0)mL。每例患者均在枢椎椎弓根狭小的一侧成功置入1枚枢椎棘突椎板螺钉,对侧置入枢椎椎弓根螺钉、椎板螺钉或峡部螺钉。枢椎棘突椎板螺钉与寰椎螺钉和枕骨固定板的连接方便,钉棒无需特殊弯棒,螺钉术中复位过程中无松动,未出现脊髓神经及血管损伤等并发症。术后患者临床症状明显缓解,JOA评分由(11.8±4.4)分提高至(14.2±2.8)分(t=-2.954,P=0.042)。X线及CT示寰枢椎序列恢复良好,ADI由(4.7±2.4)mm减小至(1.5±0.6)mm(t=3.122,P=0.035),5枚枢椎棘突椎板螺钉位置满意,整体内固定、植骨融合良好。MRI示脊髓减压充分,SAC由(8.5±3.4)mm增大至(12.5±3.7)mm(t=-2.808,P=0.048)。1例患者出现取髂骨处切口渗液,对症处理后甲级愈合。结论:枢椎棘突椎板螺钉固定技术上可行,应用于寰枢椎脱位和颅底凹陷治疗的初步临床效果满意,可作为枢椎椎弓根螺钉固定的替代技术。

Objective:To introduce C2 spinous lamina screw fixation and evaluate its preliminary clinical outcome.Methods:C2 spinous lamina screw fixation was established and applied in 5 patients with atlantoaxial dislocation and skull base depression between January and December 2022.Japanese Orthopaedic Association(JOA)score was used to evaluate neurological status.Atlanto-dental interval(ADI)was measured to evaluate atlantoaxial reduction.The space available for the spinal cord(SAC)was measured to assess spinal cord compression.The atlantoaxial sequence,C2 spinous lamina screw location,overall internal fixation and bone fusion were evaluated by X-ray and CT.Results:The operation of all 5 patients was successfully completed,including one with posterior atlantoaxial screw-rod fixation and fusion and four with posterior occipital cervical screw-rod fixation and fusion.The mean operation time was(134.6±25.2)min,and intraoperative blood loss was(150.0±50.0)mL.One spinous lamina screw was successfully inserted in the narrow side of C2 pedicle in each patient,and a pedicle screw,lamina screw or isthmus screw in the opposite side.The connection of C2 spinous laminar screw to C1 screw or occipital fixation plates was convenient,and there was no need of rod special bending.No screw loosening occurred during reduction.There were no intraoperative complications(spinal cord nerve or vascular damage).Clinical symptoms were significantly relieved and JOA score increased after operation(11.8±4.4 vs.14.2±2.8,t=-2.954,P=0.042).X-ray and CT examinations showed well atlantoaxial sequence,and ADI decreased significantly([4.7±2.4]mm vs.[1.5±0.6]mm,t=3.122,P=0.035).The position of 5 axial spinous process lamina screws was satisfactory,and the overall internal fixation and bone fusion were good.MRI showed that spinal cord decompression was sufficient and SAC increased significantly([8.5±3.4]mm vs.[12.5±3.7]mm,t=-2.808,P=0.048).The iliac crest incision was exudated in 1 patient after operation,which was healed after symptomatic treatment.Conclusions:C2 spinous lamina screw fixation is technically feasible,and its initial clinical effect is satisfactory in the treatment of atlantoaxial dislocation and skull base depression.It can be used as alternative technique for C2 pedicle screw fixation.