经皮前路侧块螺钉内固定技术在治疗上颈椎骨折中的应用

目的应用前路经皮侧块螺钉内固定治疗寰枢椎骨折,并进行术后随访及影像学评估。方法采用自行设计的一套中空穿刺器械,进行前路经皮穿刺侧块螺钉内固定同时行前部结构植骨融合术,治疗C1-2骨折38例,手术患者包括:Jeferson骨折10例,C1前弓骨折12例,寰枢椎脱位7例、半脱位5例,陈旧性齿状突骨折4例。对术后患者进行X线、CT检查,观察螺钉的位置。结果临床术后患者得到随访,平均随访2.8年,术后无严重合并症,无血管、神经损伤,无气管损伤及食管瘘,螺钉1例一侧松动,但未引起神经症状及其他合并症。1例一侧螺钉进入椎动脉孔边缘,但无椎动脉损伤。其余螺钉位置良好。结论前路经皮侧块螺钉内固定治疗C1-2操作简单,出血少,创伤小,恢复快,疗效可靠。只要采用合理的配套器械,选择正确的穿刺点及穿刺深度,该手术方法是安全可靠的。

Application of Percutaneous Anterior Lateral Mass Internal Fixation in C_(1-2) Cervical Vertebral Fracture

Objective To apply the method of percutaneous anterior lateral mass fixation for instability of C_1-2 vertebral fracture and determine the outcome of the method by radiology.Methods Thirty-eight cases of C_1-2 instability including 10 cases of Jefferson's fracture, 12 cases of anterior arch fractures of C₁, 7 cases of atlantoaxial dislocation, 5 cases of atlantoaxial subdislocation, and 4 cases of dental old fracture with dislocation were treated with percutaneous anterior lateral mass screws and bone grafting with new designed hole instrumentations. All the patients were followed-up after operation and assessed the screws position by X-ray and CT.Results All casesreached a satisfactory results of fixation without injuring the vertebral artery and spinal cord. Two screws were in poor position. One screwcame loose a year after operation, another screw went into the vertebral artery groove, but no vertebral artery injury. All the other screwswere in good position.Conclusion The operation procedure for instability of C_1-2 has the advantage of simplicity, less trauma and minimized bleeding. The operation procedure is safe with reasonable instrumentations and correct selection of the puncture point, angle and depth.