| 椎弓根螺钉在颈胸段骨折脱位中的临床运用 |
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Received:June 10, 2009
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| 作者 | Author | 单位 | Unit | E-Mail |
| 赵刘军 |
ZHAO Liu-jun |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 徐荣明 |
XU Rong-ming |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 马维虎 |
MA Wei-hu |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 蒋伟宇 |
JIANG Wei-yu |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 校佰平 |
XIAO Bai-ping |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 阮永平 |
RUAN Yong-ping |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 孙韶华 |
SUN Shao-hua |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 胡勇 |
HU Yong |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 顾勇杰 |
GU Yong-jie |
宁波市第六医院脊柱外科,浙江 宁波 315040 |
Orthopaedic Department,the 6th Hospital of Ningbo,NingBo 315040,Zhejiang,China |
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| 期刊信息：《中国骨伤》2009年22卷，第8期，第569-572页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的：评价椎弓根螺钉技术在颈胸段骨折脱位(C6 -T2)中的运用价值。
方法：2001年5月至2008年1月运用椎弓根螺钉植入技术治疗颈胸段骨折脱位患者26例，男17,女9例；年龄20～75岁，平均48.5岁。采用单纯后路椎弓根螺钉技术17例，后路椎弓根螺钉技术结合前路减压钢板内固定9例。术后3 d运用CT平扫及重建片观察评价植入颈胸段椎弓根螺钉的准确性、螺钉植入相关并发症；随访观察患者颈胸段术后植骨融合情况；统计患者术前与术后6个月JOA评分及ASIA分级改善情况，综合评价患者脊髓及神经功能改善情况。
结果：所有患者获得随访，随访时间3～74个月，平均36.5个月。4例完全性瘫痪患者术后6个月内死亡。共计植入椎弓根螺钉104枚，其中颈椎椎弓根74螺钉枚(其中：C5 16枚， C6 16枚， C7 42枚),胸椎椎弓根螺钉30枚(其中：T1 22枚，T2 8枚),所有椎弓根螺钉在术中均成功植入，无脊髓、神经根及椎动脉损伤。术后CT提示颈椎椎弓根螺钉11枚(14.9%)穿破椎弓根，其中7枚(9.5%)穿破外侧皮质，1枚(1.4%)穿破椎弓根上侧皮质，3枚(4.1%)穿破椎弓根下侧皮质。胸椎椎弓根螺钉中，3枚(10%)穿破胸椎椎弓根，其中2枚 (6.7%)穿出椎弓根外侧缘，1枚(3.3%)穿破内侧缘(< 2 mm),但无临床症状。术后随访1枚C5椎弓根螺钉断裂，但患者无明显临床症状，其余无螺钉松动及断钉情况出现。所有患者固定良好，并均达到骨性融合。术后6个月患者平均JOA评分由术前(7.5±2.0)分恢复到(14.5±2.3)分，差异有统计学意义(t=6.34,P<0.05).ASIA分级情况，除3例完全性瘫痪患者脊髓功能术后无明显改善外，余患者术后脊髓神经功能均有不同程度恢复。
结论：椎弓根螺钉在颈胸段骨折脱位治疗中安全、可靠。术者应熟练掌握颈胸段后路解剖及椎弓根螺钉植入技巧，术前要仔细测量相关影像学参数，个体化治疗每一位患者。 |
| [关键词]:颈椎 胸椎 骨折 骨折固定术,内 |
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| Application of the pedicle screws for cervicothoracic fracture-dislocation |
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Abstract:
Objective: To explore pedicle screw implantation for fracture-dislocation injuries at cervicothoracic junction (C6-T2).
Methods: Pedicle screw implantation was used for twenty-six patients with cervicothoracic fracture-dislocation from May 2001 to Jan 2008. There were 17 males and 9 females with an average of 48.5 years (range,20 to 75 years). Single posterior pedicle screw fixation was performed for 17 cases,and posterior screw fixation combined with anterior reduction and plate fixation for the other nine. The accuracy of the pedicle screws were evaluated by CT views after surgery. Complications and neurological recovery were also recorded after the procedures.
Results: All subjects were followed up from 3 to 74 months with average 36.5 months. Four cases of complete paraplegia died of cardiovascular or pulmonary failure within half a year after surgery. There were 104 pedicle screws implanted totallythe including 74 pedicle screws in cervical vertebrae, 16 at C5,16 at C6,42 at C7,and 30 pedicle screws in upper thoracic vertebrae,in which 22 at T1,8 at T2. No injury of spinal cord,nerve roots and vertebral artery was found during operation. Eleven screws(14.9%) were perforated out of the pedicles in cervical spine,in which 7(9.5%) through lateral cortex,1(1.4%) through the superior and 3(4.1%) through the inferior. Three screws(10%) were perforated in upper thoracic spine,in which 2(6.7%) by lateral cortex and 1(3.3%) by the medial (within 2 mm). Bony fusion was achieved for all cases and all internal fixator was good except 1 screw broken at C5 . JOA score increased from preoperative(7.5±2.0) to postoperative(14.5±2.3) evaluated in 6 months after operation,with statistic difference(t=6.34,P<0.05). Neurological improvement was gotten in all patients according to ASIA classification but three cases who suffered from complete neurological injuries.
Conclusion: Implantation of pedicle screws at cervicothoracic junction can be safe and reliable if the urgeonis familiar with the local anatomy of cervicothoracic spine,and the technique for implantation of the screws. Related radiological parameters should be measured for each subject before the operation in attempt to get a therapy individually. |
| KEYWORDS:Cervical vertebrae Thoracic vertebrae Fractures Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 赵刘军,徐荣明,马维虎,蒋伟宇,校佰平,阮永平,孙韶华,胡勇,顾勇杰.椎弓根螺钉在颈胸段骨折脱位中的临床运用[J].中国骨伤,2009,22(8):569~572 |
| 英文格式: | ZHAO Liu-jun,XU Rong-ming,MA Wei-hu,JIANG Wei-yu,XIAO Bai-ping,RUAN Yong-ping,SUN Shao-hua,HU Yong,GU Yong-jie.Application of the pedicle screws for cervicothoracic fracture-dislocation[J].zhongguo gu shang / China J Orthop Trauma ,2009,22(8):569~572 |
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