下颈椎椎弓根内固定术的个体化设计及临床应用探讨

[目的]探讨下颈椎椎弓根螺钉内固定术的个体化设计及临床应用.[方法]应用64排CT采集图像、Fast VR软件立体重建、PACS软件存储和传输、SYNAPSE软件三维测量.对103例下颈椎骨折脱位患者进行了临床治疗,其中9例病人各置入椎弓根螺钉8枚,计72枚；27例病人各置入椎弓根螺钉6枚；计162枚,67例病人各置入椎弓根螺钉4枚；计268枚,共计502枚.[结果]术后87例患者获12 ～73个月随访,平均随访时间18.16个月.采用JOA评分标准[1],优41例,良33例,可8例,差3例,术后并发症死亡3例,优良率85.06％.椎弓根螺钉以Andrew CT位置分级标准进行评估,Ⅰ级476枚,Ⅱ级23枚,Ⅲ级3枚,螺钉Ⅰ级率94.82％.25例患者26枚椎弓根螺钉术后X线片示位置不理想,3枚Ⅲ级螺钉行二次手术调整,无脊髓及椎动脉损伤.无钢板、螺钉脱落及断裂,融合率为98.32％.[结论]应用下颈椎椎弓根螺钉内固定置钉技术治疗颈椎疾患可以获得即刻三维稳定,融合率高,是一种值得推广的方法.

The individual design and clinical application of lower cervical spine pedicle screw internal fixation

[Objective]To approach the individual design and lower cervical spine application of cervical pedicle screw internal fixation.[Method]There were 103 cases of lower cervical spine fracture dislocation accepting clinic treatment by the application of 64-slice CT image acquisition,fast VR three-dimensional reconstruction software,PACS software,storage and transmission,SYNAPSE software three-dimensional measurement.Nine patients received 8 pedicle screws per person,totaling 72 screws,27 patients received 6 pedicle screws per person,totaling 162 screws,67 patients received 4 pedicle screws per person,totaling 268 screws,9 patients received 8 pedicle screws per person,totaling 72 cases,with total 502 screws.[Result]After operation 87 patients were followed up for 12-73 months,with an average follow-up time of 18.16 months.According to JOA score standard,41 cases were excellent,33 cases were good,8 cases were fair,3 cases were poor,3 cases were dead because of postoperative complications,and the excellent and good results rate were 85.06%.According to Andrew CT localization and standardization,476 screws were Level I,23 screws were Level II,Three screws were Level III,and the rate of Level I were 94.82%.The localization 26 screws in 25 patients were not content.Three screws of Level III were rectified through secendary operation without spinal cord and vertebral artery injury.All the plates and screws had not abscission and disruption,and union rate were 98.32%.[Conclusion]Applying the lower cervical spine pedicle technique to treat cervical disorders can gain immediately three-dimensional stability and high fusion rate,it is worthy of promotion.