摘要
目的探讨下颈椎损伤前路椎弓根螺钉固定治疗的初步临床运用。方法选择2009年1月-2011年12月运用下颈椎前路椎弓根螺钉固定治疗的下颈椎损伤患者22例。所有患者术后均摄X线片及CT以明确螺钉位置、方向、长度，是否有椎弓根皮质穿破、横突孔或椎管的侵犯，同时行MRI检查以明确术后减压情况，是否有硬膜外血肿的形成，颈脊髓变性情况。统计比较患者日本骨科学会（JOA）评分改善情况。结果术后所有患者均获得随访3—36个月，平均15．5个月。22例共置人下颈椎前路椎弓根螺钉4.4枚，所有螺钉均顺利置人。所有患者均获得骨性愈合，平均愈合时间4．5个月。所有患者随访中均未发现螺钉松动、脱出、断裂或钢板松动。1例术后出现声音嘶哑，估计与术中长时间牵拉喉返神经有关，予以营养神经等支持治疗，术后复查3周左右患者症状？肖失。2例术后诉有吞咽不适，告知患者进软食，症状3个月左右明显缓解。术后X线片示下颈椎前路椎弓根螺钉置入位置满意。术后出院前CT横断位像示2枚螺钉在下颈椎椎弓根内侧皮质1度穿破，2枚螺钉外侧缘皮质1度穿破累及横突孔内侧缘。出院前MRI示所有患者脊髓前方压迫均获得明显缓解，4例出现少量硬膜外前方血肿，但无明显脊髓压迫。术后12个月MRI示3例脊髓变性有改善。JOA评分从术前的（8．5±0．7）分提高到术后出院前（14．5±0．8）分（P〈0．01），术后6个月时达（15．7±0．7）分，较出院前又有显著改善。结论前路椎弓根螺钉固定是一项可靠和安全的下颈椎损伤前路重建技术，临床运用中要注意严格掌握手术适应证。
Objective To investigate the preliminary clinical application of anterior pediele screws in treatment of the lower cervical spine injuries. Methods The study involved 22 patients with lower cervical spine injuries treated with anterior pedicle screw technique from January 2009 to December 2011. X-ray and CT images of the patients were taken postoperatively to evaluate whether the position, orientation and length of the screws were appropriate and whether there involved pedicle cortex perforation, transverse foramen or spinal canal invasion. MRI was also performed to ascertain the situation of decom- pression, the formation of epidural hematoma and the degeneration of cervical spinal cord. The improve- ment of JOA score was compared statistically. Results All the patients were followed up for 3-36 months （ mean, 15.5 months）. A total of 44 anterior lower cervical screws were implanted and all screws were inserted smoothly. All the patients had bone healing after average 4.5 months, which showed no loosening, prolapse or breakage of the screws or no loosening of the plate. One patient showed hoarseness postoperatively, which was probably due to the long-term distraction of recurrent laryngeal nerve. The symptom disappeared at around three weeks after neurotrophic support. Two patients complained of dys- phagia postoperatively, and were informed of keeping a soft diet. The symptom was remarkably alleviated after three months or so. The X-ray films indicated satisfactory position of the implanted screws. Before discharge, the transaxial CT images showed that two screws perforated the medial pedicle cortex （ 1 ° ） and that two screws perforated the lateral cortex （ 1 ° ） and affected the medial margin of the transverse foramen. Before discharge, the MRI indicated obvious alleviation of the anterior spinal cord compression in all patients and a small amount of anterior epidural hematoma in four patients, with no obvious spinal cord compression. At 12 months after operation, the MRI showed significant improvement of spinal cord degeneration in three patients. JOA score was increased from preoperative （8.5 ± 0.7） to （ 14.5 ± 0.8 ） before discharge （P 〈 0.01 ）. JOA score was （15.7 ± 0.7 ） at six months postoperatively, which was significantly improved as compared with that before discharge. Conclusions Anterior pedicle screw fixation is a reliable and safe method for reconstruction of the anterior lower cervical injuries. Surgical indications should be strictly controlled in its clinical application.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2012年第9期780-784,共5页
Chinese Journal of Trauma
关键词
颈椎
骨折固定术
治疗结果
Cervical vertebrae
Fracture fixation
Treatment outcome
