摘要
背景：熟悉颈椎解剖及椎弓根螺钉的特性，术中规范操作以及个体化置钉等是置入治疗成功的关键。目的：了解颈椎椎弓根钉材料置入治疗颈椎骨折脱位术中和随访期内材料及宿主反应及置入后脊髓神经功能的恢复情况。设计：病例分析。单位：解放军沈阳军区总医院骨科。对象：选择2002-02／2006-02解放军沈阳军区总医院骨科具有完整随访病例资料的颈椎骨折脱位患者41例。18例合并脊髓损伤，按Frankel分级：A级6例，B级1例，C级4例，D级7例。方法：①采用经椎弓根内固定置入治疗颈椎骨折脱位41例。病例于术前行X射线片、CT及MRI检查，根据测量结果对每一椎弓根钉实施个体化置入。②所有手术均由同一术者完成，施术者为第一作者，主任医师，术者资格符合岗位技术职责要求。主要观察指标：①螺钉置入过程中材料及宿主反应。②术后及随访过程中材料及宿主反应。③置入后脊髓神经功能恢复情况。结果：41例全部获得6-12个月随访，切口均Ⅰ期愈合。①螺钉置入过程中材料和宿主反应：共置入218枚螺钉。12枚在初次置钉后有松动感，其中11枚经调整进钉点和进钉方向或，和增加螺钉直径或长度后松动感消失，另外1枚经上述处理无效后通过增加固定节段维持了稳定性。10枚钻孔后钉道出血较多，经处理后出血停止：3V0在显露时造成C1、2间静脉丛出血，经压迫止血后出血停止，其中1例因术野不清改用Apofixl内固定。②术后及随访过程中材料反应及宿主反应：共置入螺钉218枚。196枚位置正确，22枚存在不同程度偏差，其中1枚造成神经根损伤，1枚疑有血管损伤。38例获满意复位并骨性愈合，3例因系陈旧骨折脱位术中复位不完全并出现神经根刺激症状，其中1例术后因退钉而改行前路手术；其余未发现椎动脉、脊髓、神经根损伤及内固定破坏。③置入后脊髓神经功能恢复情况：18例合并脊髓损伤者神经功能除A级6例无变化外，余12例均有1-2级改善。结论：①颈椎椎弓根钉材料置入后发生生物相容性反应的几率低。②置钉后脊髓神经功能恢复较好，是治疗颈椎骨折脱位有效且相对安全的方法之一。
BACKGROUND： The characteristics of cervical anatomy and pedicle screw, operational specification, and individual screw implantation are the key factors of a successful implantation treatment. OBJECTIVE： This study was designed to investigate the cervical pedicle screw and host response as well as the recovery of spinal nerve functions during the surgery and follow-up period of cervical spine fracture-dislocation. DESIGN： A case analysis. SETTING： Department of Orthopaedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Sbenyang, Lianning Province, China. PARTICIPANTS： A total of 41 patients with cervical spine fracture-dislocation, who have complete follow-up data, were admitted to the Department of Orthopaedics, General Hospital of Shenyang Military Area Command of Chinese PLA between February 2002 and February 2006. Of the included patients, 18 were complicated by spinal cord injury （according to Frankel classification system, 6 were graded as A, 1 as B, 4 as C, and 7 as D. METHODS： Forty-one patients with cervical spine fracture-dislocation were treated by implanting a screw through the cervical pedicle and fixing it. Prior to surgery, all patients were subjected to X-ray, CT and MRI examinations. According to measurements, each cervical pedicle screw was individually implanted. The entire surgery was accomplished by Xiang Liang-bi, chief physician, whose qualification corresponds to the responsibilities. MAIN OUTCOME MEASURES： Material and host response during and after screw implantation as well as in the follow-up period. Recovery of spinal nerve function after screw implantation. RESULTS： All patients were followed up for 6-12 months and all incisions were healed primarily. Material and host response during the process of screw implantation： A total of 218 screws were implanted. After initial implantation, 12 screws were loosened, and such a phenomenon disappeared in 11 screws by adjusting inserting point and inserting direction or/and increasing screw diameter or length. The remaining 1 screw was stabilized by increasing the fixed segments. After drilling, poles of l0 screws bled much and treated by hemostasis. C1-2 venous plexus hemorrhage was caused in 3 patients and stopped by compression, and Apofix internal fixation was used in 1 of 3 patients due to unclear surgical visual field. Material and host response after surgery and during the follow-up： A total of 218 screws were inserted. Of the 218 screws, 196 were in correct position, and 22 were deviated to different degrees. Deviation of 1 screw caused injury to nerve root and that of another screw led to injury to blood vessel. Thirty-eight patients acquired satisfactory reduction and bone union. Three patients presented with symptoms of nerve root irritation due to incomplete reduction in the old fracture-dislocation. Among the 3 patients, 1 was subjected to anterior approach due to screw removed, and neither injury to vertebral artery, spinal cord, and nerve root nor internal fixation destroy was found in any other patients. Recovery of spinal nerve function after implantation： Among the 18 patients complicated with spinal cord injury, 6 patients, who were assessed as grade A spinal cord injury, did not exhibit improvement in spinal cord function, while the remaining 12 presented with 1 or 2 grades of improvement. CONCLUSION： There is a lower probability for biocompatibility reaction, and spinal nerve function recovers better after implantation of cervical pedicle screw. So implantation of a cervical pedicle screw system is an effective and relatively safe method for treatment of cervical spine fracture-dislocation.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第22期4361-4364,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
