| 下颈椎经关节螺钉钉棒系统形式固定的临床研究 |
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Received:September 19, 2010
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| 期刊信息：《中国骨伤》2011年24卷，第7期，第538-540页 |
| DOI：10.3969/j.issn.1003-0034.2011.07.002 |
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目的：探讨下颈椎经颈后正中入路采用经关节螺钉钉棒形式固定的应用。
方法：自2005年7月至2009年7月，在11例下颈椎创伤性骨折脱位，9例颈椎管狭窄的后路固定中应用经关节螺钉以Vertex钉棒系统形式固定。其中男16例，女4例；年龄29～76岁，平均51岁，均行颈椎后路经关节螺钉内固定植骨融合、减压(其中3例结合前路手术).经关节螺钉置钉
方法：以侧块中心点内侧1 mm为进钉点，进钉角度在矢状面上尾倾35°～40°，在冠状面上外倾15°～20°。术后摄颈椎X线片，评价螺钉位置和颈椎的序列和植骨融合情况。
结果：共置入经关节螺钉88枚，其中10枚于C3,4,20枚于C4,5,32枚于C5,6,26枚于C6,7.术中所有螺钉均成功置入，未出现椎动脉、神经根和脊髓损伤等置钉相关并发症且均获得植骨融合，无内固定断裂失败。JOA评分：术后1周平均改善率55.8%,其中优5例，良7例，可7例，差1例，优良率为60%;术后3个月平均改善率为74.5%,其中优6例，良8例，可6例，优良率75%.术前与术后3个月JOA评分比较有统计学差异。
结论：后路经关节螺钉钉棒形式内固定是一种有效的下颈椎固定形式，经过初步临床应用发现具有固定可靠，操作简单等优点。但这一新的固定形式，尚需长期的临床随访和观察。 |
| [关键词]:颈椎 椎管狭窄 脊柱骨折 脱位 内固定器 并发症 |
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| Clinical study of posterior transarticular fixation with rod-screw in the lower cervical vertebrae |
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Abstract:
Objective: To explore the effects of posterior transarticular fixation with rod-screw in treating fracture and dislocation,spinal stenosis of lower cervical vertebrae.
Methods: From July 2005 to July 2009,11 patients with cervical fracture and dislocation and 9 with spinal stenosis of lower cervical vertebrae underwent operation with transarticular fixation with rod-screw (Vertex system). There were 16 cases male and 4 cases female,ranging in age from 29 to 76 years with an average of 51 years. All patients underwent decompression,internal fixation and fusion through posterior approach (combined with anterior approach in 3 cases). The method of insertion of screw:the starting point located in medial 1 mm of the midpoint of the lateral mass,angle in sagittal plane was 15°-20° of caudal clinism and in coronal plane was 35°-40° of external clinism. The position of screws,the cervical array,bone graft and fusion were observed by X-ray films.
Results: A total of 88 transarticular screws were successfully inserted,10 screws located in C3,4,20 in C4,5,32 in C5,6,26 in C6,7. There were no complications related to screw insertion,such as injury of the vertebral artery,nerve roots and the spine cord. All patients obtained bone fusion without internal fixation breaking. The improvement rate of JOA was 55.8% at the 1st week after operation,5 cases got excellent results,7 good,7 fair,1 poor;the improvement rate of JOA was 74.5%,at the 3rd month after operation,6 cases got excellent results,8 good,6 fair. There was significant difference in the JOA between before operation and at the 3rd month after operation.
Conclusion: The transarticular screw fixation with rod-screw in the lower cervical spine is an effective fixation,which has advantages of rigid stability,convenience to perform,and can reduce operative risk in initial application,but the long-term follow-up is very necessary. |
| KEYWORDS:Cervical vertebrae Spinal stenosis Spinal fractures Dislocations Internal fixators Complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 周雷杰,陆继业,梁彪,徐荣明.下颈椎经关节螺钉钉棒系统形式固定的临床研究[J].中国骨伤,2011,24(7):538~540 |
| 英文格式: | ZHOU Lei-jie,LU Ji-ye,LIANG Biao,XU Rong-ming.Clinical study of posterior transarticular fixation with rod-screw in the lower cervical vertebrae[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(7):538~540 |
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