重建钢板螺钉在枕颈融合中的应用

目的：探讨重建钢板螺钉在枕颈融合中的应用效果。方法：回顾分析应用重建钢板螺钉固定行枕颈融合5例病人的临床资料和手术效果。结果：术中、术后无并发症发生，经5～18个月的随访，全部病例3个月达到骨性融合，未见钢板折断、拔钉、断钉等。JOA骨髓功能评分分别提高2～5分。结论：运用重建钢板行枕颈融合固定是一种较方便、牢固、经济的方法。     

钢板螺钉内固定在枕颈融合中的应用

目的探讨钢板螺钉内固定在枕颈融合中应用的疗效。方法1999年3月-2003年7月，应用钢板螺钉内固定枕颈融合治疗难以复位的寰枢椎脱位并脊髓压迫11例，其中齿突陈旧性骨折并寰椎前脱位7例，齿突发育不良并寰椎后脱位4例。结果寰枢椎脱位获得不同程度的复位，脊髓压迫解除，神经功能明显改善，枕颈部3～5个月骨性融合。结论对于难以复位的寰枢椎脱位应用钢板螺钉内固定枕颈融合术，不但固定较牢固可靠、简便，有利于植骨融合，而且还有一定的复位作用。     

枕颈CD内固定在枕颈融合术中的应用

目的：研究枕颈CD内固定在枕颈融合术中的价值和作用。方法：对13例上颈椎不稳患者行枕颈部自体植骨融合枕颈CD内固定术。其中包括寰枢椎肿瘤4例,陈旧性寰枢椎骨折脱位4例,枕寰枢椎复合性畸形4例,陈旧性横韧带断裂伴寰椎前脱位1例。结果：13例患者均获随访5－27个月,平均10个月。所有病例植骨均完全愈合,无一例发生枕颈CD椎板钩及螺钉松动等并发症。结论：枕颈CD可提供有效的节段固定,适用于枕颈不稳的治疗。     

枕颈钢板固定融合治疗齿突骨折伴脊髓损伤

目的 探讨齿状突骨折与迟发性脊髓损伤关系及外科治疗方法选择。方法 对7例齿突骨折伴迟发性脊髓损伤患者全部施行槽式钢板内固定及取髂骨植骨融合术。随访6个月－48个月,平均28个月。结果 7例枕颈植骨全部融合,功能评价：优6例,良1例。结论 认为陈旧性齿突骨折,造成寰枢椎不稳,最终导致寰枢椎脱位及脊髓压迫,应积极选择牵引复位,后方减压,坚强内固定及枕颈融合术。     

枕颈植骨融合内固定术治疗枕颈畸形

2008年1月～2011年1月,我科对16例枕颈畸形患者采用枕颈植骨融合内固定术,取得良好效果,报道如下. 1材料与方法 1.1病例资料本组16例,男9例,女7例,年龄26 ～58岁.患者术前均行颈椎X线、CT三维重建及MRI检查,诊断为枕颈畸形.其中颅底凹陷并寰椎枕化7例,寰椎后弓缺如4例,C2～3先天融合4例,C4～5先天融合合并寰枢关节不稳1例.合并症:10例脊髓空洞,8例小脑扁桃体下疝,1例脑积水.     

枕颈融合联合扩大成形减压治疗枕颈区畸形

目的探讨枕颈融合联合扩大成形减压术在治疗枕颈区畸形中的应用价值。方法对18例枕颈区畸形患者行后路颈椎管扩大成形、脊髓减压、枕颈融合、取髂骨植骨内固定术。采用JOA评分评价患者功能改善情况。结果患者均获得随访,时间13～38个月。15例术后3个月植骨融合,3例术后6个月植骨融合。无脑脊液漏、脊髓损伤加重、脊髓空洞等并发症。术后12个月JOA评分为13～18(15. 42±0. 52)分,较术前8～12(11. 52±0. 79)分明显改善(P 0. 05),改善率为71%。结论枕颈融合联合椎管扩大成形术能有效解除枕颈段脊髓压迫、稳定上颈椎,是脊髓减压、重建上颈椎稳定性有效、可靠的方法。     

枕颈钉板系统在枕颈融合中的应用

目的:评价颈椎经椎弓根螺钉固定行枕颈融合的临床效果,介绍应用方法。方法:利用颈椎椎弓根螺钉钢板系统,行枕颈融合11例,其中寰枢椎脱位6例(齿状突骨折不愈合4例,类风湿性关节炎2例),上中段颈椎椎管内肿瘤3例,枕颈部先天性畸形2例。结果:术后平均随访13个月(3个月~2年),所有患者植骨愈合牢固,临床症状显著改善,无脱钉、断钉等并发症。结论:利用枕颈板钉系统(occipitocervicalplate-screwssystems)行枕颈融合术固定坚强,临床效果理想,是枕颈融合可选用的内固定方法之一。     

枕颈内固定系统在枕颈融合术中的应用

目的：探讨枕颈内固定系统在枕颈融合术中的应用价值。方法：对23例因先天性发育畸形、陈旧性骨折脱位及肿瘤所致的上颈椎不稳者在行枕颈融合术同时应用枕颈内固定系统行枕颈部内固定术。术后进行6～24个月(平均22个月)随访。结果：术后症状缓解，神经功能改善者占91％(21／23)，术后9个月植骨融合率达到100％。无内固定棒钉断裂及脱钩现象，仅有1例术后3个月出现枕骨部螺钉松动。结论：在行枕颈融合时应用枕颈内固定具有可获得术后枕颈部即刻稳定，防止植骨块移位，术后无需卧石膏床和提高植骨融合率等优点。     

枕骨板障间螺钉联合枢椎椎弓根螺钉固定在枕颈融合术中的初步应用

目的 探讨枕骨板障间螺钉联合枢椎椎弓根螺钉固定技术在上颈椎不稳的应用效果.方法 采用枕骨板障间螺钉联合枢椎椎弓根螺钉固定治疗上颈椎不稳11例.结果 11例随访6～18个月,平均10.6个月.术前脊髓压迫症3例,术后均有不回程度的改善,所有病例均在3～6月内植骨融合,未见内固定松动和断裂等,无脊髓、神经根和椎动脉损伤等并发症.结论 使用枕骨板障间螺钉联合枢椎椎弓根螺钉固定行枕颈融合术,是一种固定可靠、操作简单、临床效果理想的内固定方法 .     

可吸收螺钉在颈椎前路固定术中的应用

1995年10月至1996年10月,作者采用可吸收螺钉对14例颈椎前路手术行植骨块内固定术。术后随访平均8.3个月。患者脊髓压迫症状缓解,植骨块稳定,植骨全部愈合,疗效优良。作者认为:可吸收螺钉内固定可靠,不需二次手术取出,不干扰磁影像,无毒性,无副作用,是颈前路内固定的理想材料。     

颈椎侧块钢板螺钉内固定治疗下颈椎骨折脱位

目的应用颈椎侧块钢板螺钉内固定术治疗下颈椎骨折脱位。方法应用该固定方法治疗下颈椎骨折脱位14例。其中单侧小关节骨折脱位3例，双侧4例；单侧小关节脱位2例，双侧4例；双侧小关节脱位合并椎体压缩骨折1例。无神经根损伤者3例，仅合并神经根损伤者5例，合并脊髓损伤者6例（完全性2例，不完全性4例）。切开复位，将螺钉固定于颈椎侧块上，配以钢板连接和植骨，实现坚强固定。结果本组14例随诊时间为8～40个月，平均28个月。平均融合时间是6个月。术后2周可在围领保护下坐起，术中无血管、神经损伤。单纯神经根损伤者症状完全消失，4例脊髓不完全损伤者Frankel分级提高1级。结论颈椎侧块钢板螺钉内固定术具有固定节段短，固定作用强，术后仅需一般外固定，可早期活动等优点。     

Operative Treatment of Clavicle Midshaft Fractures: Comparison between Reconstruction Plate and Reconstruction Locking Compression Plate

Background

To compare the outcomes of reconstruction plate and reconstruction locking compression plate (LCP) for the treatment of clavicle midshaft fractures.

Methods

Forty one patients with a clavicle midshaft fracture were treated by internal fixation with a reconstruction plate (19 patients) or reconstruction LCP (22 patients). The clinical and radiological results were evaluated according to the Quick Disability of the Arm, Shoulder, and Hand (DASH) score and plain radiographs.

Results

The mean time to union was 14.6 weeks in the reconstruction plate group compared to 13.2 weeks in the reconstruction LCP group (p > 0.05). The mean score to Quick DASH was 33.85 points in the reconstruction plate group compared to 34.81 points in the reconstruction LCP group (p > 0.05). The complications in the reconstruction plate were hypertrophic scarring in 2 cases, painful shoulder in 2 cases, limitation of shoulder motion in 2 cases, and screw loosening in 3 cases. In addition, the complications in the reconstruction LCP group was hypertrophic scarring in 4 cases, painful shoulder in 1 case and a limitation of shoulder motion in 1case (p > 0.05).

Conclusions

This study showed radiologically and clinically satisfactory results in both groups. Overall, operative treatment with a Reconstruction plate or reconstruction LCP for clavicle shaft fractures can be used to obtain stable fixation.     

Occipital Bone Graft for Atlantoaxial Fusion

Summary  Background. Instability of the atlantoaxial segment is frequently encountered in neurosurgical practice. Numerous fusion techniques have been employed at this level. Most commonly, arthrodesis is achieved through bone and wire techniques. We have employed the use of suboccipital bone in lieu of iliac crest autograft in order to avoid the significant morbidity associated with iliac crest graft harvest.  Methods. Twenty one patients suffering instability from various etiologies underwent C1–C2 fusion at our institution using occipital bone graft and wire fixation. A small craniectomy was performed near the foramen magnum, and the bone graft was notched and secured in place using wire fixation. Patients were placed in a Philadelphia or Aspen collar for 6–12 weeks postoperatively, and flexion/extension plain film of the cervical spine were used to evaluate fusion.  Results. Long term follow up was available on all patients (mean 32 months, range 12–48 months). Fusion was achieved in 81% of patients within 12 weeks. Specifically, 71% (5/7) of rheumatoid patients were successfully fused. All patients with traumatic C1–C2 instability were fused. No complications were associated with the harvest of the occipital bone.  Conclusion. The results of fusion via this technique are comparable to other reported series of C1–C2 fusion. Additionally, the complications associated with iliac crest graft harvest were avoided by the use of occipital bone graft. Occipital bone appears to be a suitable bone graft substance for fusion of the C1–C2 level.     

Cost Advantages of Two-Level Anterior Cervical Fusion with Rigid Internal Fixation for Radiculopathy and Degenerative Disease

Background

Conventional anterior cervical discectomy with fusion is thought to require postoperative neck immobilization for the promotion of bony fusion. Rigid internal fixation with anterior cervical plates may decrease graft-related complications and provide immediate stability. This stability may obviate postoperative external immobilization.

Methods

This report reviews one surgeon’s experience with the use of rigid internal fixation for two-level anterior cervical discectomy and fusion for radiculopathy to promote early mobilization without external bracing. It compares outcomes and costs with a similar population of patients treated with anterior cervical discectomy and fusion who did not undergo rigid internal fixation. We compared patients who underwent two-level allograft anterior cervical discectomy and fusion with or without rigid internal fixation between 1989 and 1994 performed by a single surgeon (FJP) to evaluate the cost advantages and outcome of each procedure. All patients had clinical evidence of cervical radiculopathy unresponsive to medical therapy with magnetic resonance imaging confirmation of the appropriate nerve root impingement. Thirty-nine patients underwent two-level Cloward allograft fusion using Synthes anterior cervical locking plates, 25 underwent identical fusion without plating. Follow-up was 6 months to 4 years (mean, 31 months).

Results

Twenty-three of 25 patients in the nonplated group and 36 of 39 patients in the plated group achieved excellent or good outcomes using the Odom criteria. There were six complications (two major and four minor) in each group. Patients who underwent plating returned to light activities (mean, 17 vs. 29 days), driving (28 vs. 57 days), and unrestricted work (66 vs. 136 days) sooner than nonplated patients (p < 0.05, paired t test). No patient with plates was given external immobilization.

Conclusions

Two-level anterior cervical discectomy and fusion with anterior plating for radiculopathy is safe, effective, and seems to provide shorter convalescence compared with conventional anterior cervical discectomy and fusion. Patients returned to unrestricted work sooner, thus reducing short-term disability. Rigid internal fixation may provide cost advantages to patients and insurance disability providers. The authors conclude that the increased cost of treatment for rigid internal fixation is more than offset by the benefits of earlier mobilization.     

Anterior Interbody Fusion with the BAK-Cage in Cervical Spondylosis

Summary BAK-C is a new autostabilizing interbody cage which is implanted during an anterior cervical procedure to provide stability to the motion segment and allow fusion to occur. Special intrumentation is provided with a bone collecting reamer. The system utilizes surgical site bone graft as the osteo-inductive material within the implant. Biomechanical testing indicates improved stability and animal studies show good fusion. The basic principle is distraction-compression using the tension forces of the annulus fibrosus. Operative material concerns a two years experience with 80 patients (101 levels), 72 with cervical radiculopathy, 8 with myelopathy. Clinical evaluation is assessed on a ten point analogue pain scale for neck and arm/shoulder pain, with neurological examination. Radiological evaluation includes dynamic X-rays, myelo-CT and MRI. Patients are re-evaluated at 1, 6, 12 months postoperatively. Results for neck and radicular pain is excellent, but neurological recovery for radiculopathy and myelopathy is quite different. Radiological results are also good with (except one case) no instability, no cage migration, no kyphosis, no pseudarthrosis. Bone fusion is assessed at 6 and 12 months. Complications are few with proper technique, mainly correct distraction, symmetrical endplate drilling and lateral X-ray control. Only one patient needed an early re-operation with additional miniplate fixation. Immediate stability with good clinical response and no graft morbidity are the advantages of this implant compared to conventional cervical interbody grafting techniques.     

前路短节段限制性与非限制性钢板对颈椎曲度影响的分析

目的明确颈椎前路短节段非限制性与限制性钢板对融合节段及颈椎整体曲度的影响。方法 2000年3月至2005年12月连续诊治55例行颈椎前路单节段或双节段减压植骨融合内固定的脊髓型颈椎病及颈椎间盘突出症患者,男34例,女21例,平均年龄52岁。其中采用颈椎前路限制性钢板固定31例,非限制性钢板固定24例。全部植骨材料均取自于自体髂骨。测量术前、术后及随访时颈椎整体及融合节段的曲度并进行统计学分析。临床疗效分析采用JOA评分。统计学方法采用配对t检验。结果随访时间12～60个月,平均28个月。对融合节段,限制性与非限制性钢板术后均可显著改善其曲度。至随访时,可发现非限制性钢板固定下的融合节段曲度可得到进一步的改善。对于颈椎整体曲度,两种钢板均可以明显改善整体颈椎曲度并可有效保持。JOA评分与术前比较有显著提高（P〈0.05）。结论非限制性钢板在维持融合节段曲度方面较限制性钢板有较好的表现,但二者在维持颈椎整体曲度方面无明显差异。手术操作技术对于颈椎曲度的恢复具有决定性意义。     

经前路椎间孔减压植骨固定治疗神经根型颈椎病

目的探讨经前路颈椎间孔减压植骨融合内固定术治疗神经根型颈椎病的疗效。方法回顾分析我院自2005年1月至2008年12月对21例神经根型颈椎病患者采用的经前路颈椎间孔减压植骨融合内固定术治疗。采用日本骨科学会（Japanese orthopaedics association,JOA）及视觉模拟评分（visual analogous scale,VAS）评分,观察术前、术后即刻、6个月、18个月疗效。结果共治疗观察21例患者,采用JOA评分,术前评分（8.50±1.25）分,随访终末评分（13.70±1.33）分,手术前后JOA评分具有显著性差异（P〈0.05）。VAS评分：术前评分（6.85±1.18）分,随访终末评分（2.15±1.30）分,手术前后VAS评分具有显著性差异（P〈0.05）。术后12个月植骨融合率为100%;术前Cobb角为10.3°（-5°～16°）,随访终末Cobb角为15.5°（0°～20.5°）;术后均无感染、喉返神经、喉上神经及椎动脉损伤,切口均一期愈合;无翻修手术者。结论经前路颈椎间孔减压植骨融合内固定术治疗神经根型颈椎病具有创伤小、减压直接、疗效确切的优点。