Quadrant通道下经椎旁肌间隙入路椎弓根螺钉治疗上颈椎骨折

目的]探讨Quadrant通道下经椎旁肌间隙入路椎弓根螺钉治疗上颈椎骨折的安全性及有效性。方法]2015年1月~2016年12月,采用Quadrant通道下经椎旁肌间隙入路微创椎弓根螺钉治疗15例上颈椎骨折患者,其中男11例,女4例;年龄19~46岁,平均(33.45±9.70)岁。受伤至手术时间1~4 d,平均(2.19±1.10)d。寰椎骨折6例,枢椎骨折7例,寰枢椎骨折2例。Frankel分级:D级5例,E级10例。比较术前及末次随访的Frankel分级、日本矫形外科协会(JOA)评分、视觉模拟评分(VAS)。结果]15例患者均顺利完成手术,术中未出现脊髓损伤及椎动脉破裂等并发症。手术时间75~120 min,平均(89.13±27.85)min;术中出血量40~180 ml,平均(96.20±43.26)ml。1例患者术后出现右后枕部皮肤麻木,对症处理1周后症状消失。所有患者切口均一期愈合,无感染。术后随访12~36个月,患者神经功能完全恢复,末次随访时Frankel分级均为E级。JOA评分从术前平均(8.13±1.91)分提高至末次随访时(13.20±2.75)分,VAS评分从术前平均(7.26±1.64)分改善至末次随访时(1.202.47),差异均有统计学意义(P<0.05)。影像评估方面,术后正侧位X线片和CT检查证实损伤节段复位满意,螺钉位置良好,所有患者骨折均获骨性愈合,平均愈合时间(12.90±5.42)周。结论]Quadrant通道下经椎旁肌间隙入路微创椎弓根螺钉治疗上颈椎骨折具有组织损伤轻、出血少和降低手术创伤导致的椎旁肌退变以及术后颈背部疼痛、僵硬的发生率等优点。

Posterior pedicle screw fixation through paraspinal approach by quadrant channel for upper cervical spine fractures

Objective]To investigate the feasibility and safety of posterior pedicle screw fixation through the paraspinal ap⁃proach by quadrant channel for upper cervical spine fractures.Methods]From January 2015 to December 2016,15 patients,including 11 males and 4 females aged from 19 to 46 years with a mean of(33.45±9.70)years at surgery,underwent posterior pedicle screw fixation through the paraspinal approach by quadrant channel for upper cervical spine fractures.The time elapsed between injury and surgery varied from 1 to 5 days with a mean of(2.19±1.10)days.Of them,6 patients suffered from atlas frac⁃tures,7 were of the axis fractures and 2 were of combined fractures of the atlas and axis.According to Frankel grading system,5 cases were of Grade D and the remaining 10 of Grade E before operation.The Frankel grade,Japanese Orthopedic Association(JOA)score and visual analogue scale(VAS)for pain score were compared between the time points preoperatively and at the lat⁃est follow-up.Results]All the 15 patients had surgical procedures conducted successfully,without intraoperative complica⁃tions,such as spinal cord injury and vertebral artery rupture.The surgical procedure lasted for(89.13±27.85)mins on average ranged from 75 to 120 mins,associated with blood loss of(96.20±43.26)ml on average ranged from 40 to180 ml.One patients had numbness on the right occipital area,which disappeared 1 week later by symptomatic management.All the patients achieved primary incision healing without infection.During follow-up period ranged from 12 to 36 months,the patients got complete recovery of neurological function with Frankel grade of E in all of them at the latest interview.The JOA score significantly increased from(8.31±1.91)before operation to(13.25±2.75)at the latest follow up,whereas the VAS score significantly decreased from(7.26±1.64)to(1.20±4.47)corre⁃spondingly,which proved statistically significant(P<0.05).In term of radiographic assessment,satisfactory fracture reduction and proper position of implants placed were revealed in all of them by postoperative X-rays and CT scans,and bony union of fractures achieved in all patients at(12.90±5.42)weeks on average.Conclusion]The posterior pedicle screw fixation through the paraspinal approach by quadrant channel for upper cervical spine fractures has advantages of minimizing iatrogenic trauma,reducing blood loss,and decreasing the risk of postoperative cervicodorsal pain.