摘要
目的:为提高内固定置钉的一次成功率,利用辅助检查资料为寰枢椎椎弓根螺钉的置钉制定简单、实用的个性化方案。方法:选择2002-01/2006-09解放军第二五一医院骨科患者31例。术中采用自制的寰枢椎定位导向器,根据寰枢椎椎弓根X射线-CT个体化测量的结果,确定进钉点、入钉的角度,选择直径及长度合适的椎弓根螺钉置入。寰椎椎弓根进钉点:左侧(19.93±1.32)mm,右侧(19.16±1.30)mm,寰椎椎弓根向内侧进钉角度:左侧(23.72±2.09)°,右侧(23.35±1.91)°,寰椎向头侧进钉角度(9.00±1.20)°。枢椎椎弓根进钉点:左侧(13.14±0.82)mm,右侧(13.85±0.79)mm。枢椎椎弓根向内侧进钉角度:左侧(24.52±1.26)°右侧(20.42±1.42)°,枢椎向头侧进钉角度(25.00±3.00)°。结果:①对31例患者置入124枚椎弓根螺钉,1次置钉成功122枚螺钉,正确率为98.39%,有2枚因内倾角偏差不够,穿破椎弓根的外侧骨皮质而改为2次定位。②2例术后出现枕大神经痛,经对症治疗1个月后痊愈,2例螺钉穿破寰椎左侧椎弓根外侧壁,未发现脊髓、椎动脉损伤。③所有患者X射线片显示寰椎完全复位,枢椎齿状突骨折处对位良好。CT片示螺钉与椎动脉的脊髓位置关系良好。④平均随访10.5个月,均获得骨性融合,未发现钉板断裂材料反应。⑤按JOA评分标准,优16例,良12例,可2例,差1例,优良率90.32%。结论:X射线-CT个性化设计方案可提高寰枢椎椎弓根螺钉的置入成功率。
AIM： Based on related data, to formulate a simple and practical individualized protocol for atlantoaxial pedicle screw-plate system to improve the one-off success rate of screw implanting. METHODS： Thirty-one cases were selected from Department of Orthopedics, the 251 Hospital of Chinese PLA between January 2002 and September 2006. Under the guidance of self-made atlantoaxial localization speculum, the entrance point for screw insertion and insertion angle, screw diameter and length were determined according to the results of X-ray and CT measurement. Screw was inserted at left （19.93±1.32） mm, and right （19.16±1.3） mm; Screw insertion inside angle was left （23.72±2.09） ° , and right （23.35 ±1.91） ° ; Screw angle to side of head by pedicle of atlas was （9.00± 1.20） ° . Entrance point for screw insertion by pedicle of axis was left （13.14±0.82） mm, and right （13.85 ±0.79） mm. Screw insertion inside angle was left （24.52 ± 1.26） ° , and right （20.42 ± 1.42） ° ; Screw angle to side of head by pedicle of atlas was （25.00 ± 3.00） ° . RESULTS： （1）124 screws were implanted in 31 patients, and 122 screws were of one-off success. The precision rate was 98.39%. Two screws were secondly inserted because of cutting lateral cortical bone of pedicle for deviation of inward angle. （2）Occipital neuralgia was found in 2 cases postoperatively and cured after one month of treatment; screws penetrated atlas left vertebral lateral wall of 2 cases; no spinal or vertebral artery injury was found. （3）Radiographs showed that atlas was completely reduced, and apposition of dentoid process of axis fracture was good. （4）The follow up was averaged of 10.5 months. Bony fusion was found in the patients. No screw-plate breakage was found. （5）By JOA scale, there were 16 cases of excellent, 12 cases of good, 2 cases of fine, and 1 case of poor. The excellent rate was 90.32%. CONCLUSION： Atlantoaxial pedicle screw-plate implantation can be improved based on X-ray and CT protocol.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第13期2425-2428,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
