颈椎后路椎弓根螺钉系统C2,3短节段固定材料置入治疗Hangman骨折

目的：分析椎弓根螺钉系统短节段内固定材料置入治疗枢椎椎弓根骨折（Hangman骨折）的临床疗效，评价其应用价值。 方法：回顾性分析四川省人民医院骨科自2004年以来收治的枢椎椎弓根骨折17例患者，按Levine-Edwards分型，其中Ⅱ型4例，ⅡA型6例，Ⅲ型7例，脊髓功能按Frankel分级，12例E级，5例D级；行颅骨牵引复位病情稳定后用椎弓根螺钉系统（美敦力枢法模产品）短节段置入材料固定C2，C3椎弓根。 结果：术中无椎动脉损伤及脊髓损伤，术后摄片及CT检查显示1例两侧椎弓根骨折未复位，其余均复位良好；1例出现脑脊液漏，经常规治疗痊愈。所有病例随访12~24个月，平均14.5个月，骨折均在6个月内愈合，颈椎活动无明显受限，神经功能4例D级恢复至E级。术中所用材料均为钛合金体内置入物，与人体组织的生物相容性好，到随访结束时，无血液、免疫、组织等反应；亦无钛合金腐蚀、磨损等材料反应的发生。 结论：椎弓根螺钉系统短节段固定材料置入治疗Hangman骨折，复位固定及骨折愈合良好，对颈椎功能影响小，神经功能恢复满意。     

前后路联合手术治疗颈椎骨折脱位并脊髓损伤临床观察

目的探讨前后路联合手术治疗颈椎骨折脱位合并脊髓损伤患者的临床疗效。方法我院诊治的颈椎骨折脱位伴有脊髓损伤的30例患者,给予前后路联合手术,并对其进行减压复位内固定治疗,现回顾性分析其病例资料。结果 30例颈椎骨折脱位伴有脊髓损伤患者,经过前后路联合手术方式进行治疗后,全部治愈出院,术后平均随访12个月,未出现严重术后并发症,拍片复查结果显示骨折愈合良好,未出现脊柱畸形,脊髓功能也有不同程度的恢复。结论对于颈椎骨折脱位伴有脊髓损伤患者,前后路联合手术减压复位内固定治疗明显提高其临床疗效,而且降低并发症的发生率,值得临床广泛推广。     

颅颈交界区后路螺钉内固定

目的 报告C2椎弓根螺钉结合C1侧块或枕骨螺钉用于颅颈交界区后路内固定的解剖研究及临床应用结果.方法 福尔马林固定的头颈标本4个,根据解剖标志分别植入C2椎弓根及C1侧块螺钉,然后行CT扫描及重建,观察螺钉位置.2004年5月至2007年1月,利用C2椎弓根一C1侧块/枕骨螺钉内同定9例病人,男4例,女5例,年龄12～68岁,平均38岁;各种原因引起的C1～C2半脱位6例,因颅底凹陷经口腔齿状突切除后1例,斜坡脊索瘤经口腔切除手术前2例;采用C2椎弓根-C1侧块螺钉技术4例,C2椎弓根一枕骨螺钉技术5例,手术后均行CT扫描观察螺钉位置.结果 手术中直接显露C2椎弓根内上缘,并以此确立进钉方向,在椎弓根峡部后缘确定进钉点,可保证C2椎弓根螺钉的安全植入;直接显露C1侧块后正中确立进钉点,可避免螺钉植入过程中的椎动脉损伤.9例病人中,手术后CT复查有2例病人两颗螺钉穿破骨皮质,但末造成血管及神经的压迫,其余螺钉位置均较好;随访4-32个月,1例临床症状较术前无变化,其余8例均改善.结论 C2椎弓根-C1侧块/枕骨螺钉技术可安全有效地用于颅颈交界区内固定.     

金属植入物内固定治疗四肢骨折后的骨不连

背景：骨折的愈合除了与骨折类型、骨折局部血运及感染等因素有关之外，还与内固定物的选择、使用及规范操作有着很大的关系。 目的：分析不同植入物内固定治疗四肢骨折后出现骨不连的原因，并探讨有效的治疗方法及合适的内固定物选择方案。 方法：由第一作者采用电子检索的方式，在万方数据库(http://www.wanfangdata.com.cn/)中检索2000-01/2010-05有关骨折内固定后骨不连及治疗骨不连的研究文章，关键词为“骨折，内固定，骨不连”。排除重复研究或Meta分析类文章，筛选纳入25篇文献进行深入分析。 结果与结论：四肢骨折内固定后骨不连的发生率除了与骨折类型、骨折断端血运以及感染等因素有关之外，还与操作技术，尤其是内固定物选择以及内固定的使用方式有直接关系。对于许多骨折，如何针对骨折的类型，选择合适的内固定物以及准确的操作技术是维持内固定物长久有效性、促进骨折愈合的重要因素。虽然由于受伤机制的不同，四肢骨折会有许多复杂的类型，并对骨折愈合有一定的影响，但随着骨折内固定材料的不断推陈出新，对不同部位、不同类型的骨折有着越来越多针对性的固定方式。内固定物的选择及使用方式的准确与否，对于骨折内固定后的愈合有着很大的影响。     

下颈椎前路内固定联合后路经关节金属螺钉置入固定的生物力学稳定性

背景：对退变性颈椎管狭窄单纯采用前路椎体次全切除或椎间盘切除或单纯后路单开门椎管扩大成行均不能彻底完成脊髓减压和脊柱三柱稳定。 目的：探讨下颈椎前路固定联合后路经关节螺钉固定的生物力学稳定性。 方法：正常成人尸体颈椎标本,每具分别制作以下两种模型：①经后路C3~C7单开门和下颈椎前路C5椎体次全切除钛网支撑植骨、ORION内固定模型(对照组)。②经后路C3~C7单开门和经关节螺钉内固定及下颈椎前路C5椎体次全切除钛网内植骨、ORION内固定模型(实验组)。 结果与结论：实验组在前屈、后伸、左、右侧屈及左、右旋转移位角度均小于对照组(P < 0.001)。提示：①在生物力学实验中,下颈椎前路固定联合后路经关突节螺钉固定的生物力学性能优良,对抗前屈、后伸、左、右旋转的作用力更强,颈椎可获得更可靠的稳定性。②下颈椎前路固定联合后路经关节螺钉固定在对抗颈椎前屈运动时力学稳定性更为强大。     

高位腰椎间盘突出症前后路植骨结合金属植入物内固定治疗效果的对比☆

目的：对比观察高位腰椎间盘突出症患者行前后路植骨结合金属植入物内固定治疗效果的比较。 方法：选择2002-09/2006-09中南大学湘雅二医院脊柱外科收治的高位腰椎间盘突出症患者33例,男20例,女13例;年龄34~61岁,平均52.5岁。全部为单一间隙椎间盘突出,其中T12~L1突出1例,L1/2突出6例,L2/3突出10例,L3/4突出16例。33例患者根据手术入路不同分为2组：后路组(n=18)：行后路双侧小关节切除自体小关节骨质及自体髂骨或异体人工骨椎间植骨及椎弓根钉内固定(经后方椎板切除入路);前路组(n=15)：行前路椎间盘切除植骨及钛板内固定(经侧前方入路)。比较两组患者的临床治疗基本情况,应用JOA 评分评价患者金属内固定材料植入前后及随访时的神经功能,总结并发症,观察植骨融合情况。 结果：33例患者均获得随访,随访时间18~48(40.5±3.0)个月,在内固定时间及金属材料植入过程中出血量计算经后方椎板切除入路优于前外侧入路,但在临床症状改善率以及神经损伤发生率方面两种方式没有显著性差异。后路组植入中2例硬脊膜撕裂,1例椎弓根螺钉位置偏斜,JOA评分由内固定前(12.84±2.59)分提高到随访时的(25.63±3.06)分,优良率为88%,随访时骨性融合率为94%;前路组植入中1例硬脊膜破裂,1例植入后单侧神经根麻痹,1例植入后出现难制性呃逆,JOA评分由内固定前(11.96±2.14)分提高到随访时的(24.92±3.91)分,优良率为84%,随访时骨性融合率93%。 结论：前路或后路手术治疗高位腰椎间盘突出症均可获得良好的临床疗效,可根据术者的熟练程度选择术式,同时应进行内固定融合。     

颈前路寰枢椎骨折复位经关节突侧块螺钉、钛板内固定的手术配合

目的探讨全麻下经颈前路行寰枢椎骨折复位经关节突侧块螺钉、钛板内固定术的手术配合。方法对20例因外伤引起的齿状突骨折和／或枢椎骨折行颈前路植骨螺钉、钛板内固定术。术前访视做好患者的心理护理，根据患者的个体差异制订护理计划，准备好专用的仪器和器械。巡回护士协助手术医生摆放合适的体位，正确调节各种仪器设备，保证功能正常。术中积极主动配合手术医生、麻醉医生。洗手护士准确、敏捷地传递器械，保证手术安全顺利地进行。结果患者的平均手术时间为2h，手术顺利，诱发电位无明显变化，术后安全送人麻醉恢复室。结论通过在手术过程中的配合．让护士认识寰枢椎骨折经手术复位病人的特殊性及寰枢椎在生理解剖上的重要性，明确行鼻插管对手术的意义，熟练掌握手术器械的准备、术中的配合及手术体位的摆放，增强护士的责任心及对专科手术的配合能力。     

老年踝关节旋后外旋型骨折金属植入物内固定方式及内固定物选择

背景：为了恢复关节的功能,移位的旋后外旋型踝关节骨折常常需要切开复位内固定。老年人由于存在骨质疏松,实施内固定存在一定困难,而且容易出现伤口并发症。 目的：探讨老年移位的踝关节旋后外旋骨折手术治疗方式及内固定物的选择。 方法：选择北京大学第一医院骨科收治的移位踝关节旋后外旋型骨折患者128例,其中单纯外踝骨折29例,双踝骨折52例,三踝骨折47例。外踝选用前外侧切口98例,后外侧切口30例;后侧防滑接骨板固定6例,加压螺钉与中和接骨板固定122例(其中1/3管状接骨板98例,锁定接骨板24例);内踝骨折均使用空心加压螺钉固定;后踝骨折通过后外侧切口复位固定24例。术后根据骨折稳定情况,选择是否使用石膏外固定。随访时,根据X射线平片评估骨折愈合情况,采用Olerud and Molander评分系统进行评定。 结果与结论：128例患者均获得随访,随访时间12~25个月,骨折均愈合。外踝伤口延迟愈合5例(4%),其中锁定接骨板固定者3例、1/3管状板2例,两者间差异无显著性意义(P > 0.05)。无深部感染发生。骨折愈合后关节功能评分优55例,良61例,可10例,差2例,优良率91%。骨折愈合后,因局部不适取出内固定物31例,其中管状接骨板19例,锁定接骨板12例,两者相比,差异有显著性意义(P < 0.05)。在取出的12例锁定接骨板中,2例(17%)发生螺钉与接骨板间的“冷焊接”。1例防滑接骨板固定后出现腓骨肌腱炎,保守治疗后疼痛缓解。提示针对老年人移位的踝关节旋后外旋型骨折,合理选用手术入路和内固定物有利于减少伤口的并发症,解剖复位和良好的内固定有利于骨折恢复。     

颈前路钢板置入内固定加椎间植骨治疗Ⅱ型Hangman骨折的生物力学评价

背景：C2/3椎间盘切除，钢板置入内固定加椎间植骨是治疗Hangman骨折的常用术式。该术式在临床应用广泛，但目前尚缺乏相关实验评价钢板置入内固定治疗Hangman骨折的生物力学特点研究。 目的：评价钢板置入内固定+椎间植骨治疗Ⅱ型Hangman骨折的生物力学稳定性。 方法：6具正常成人新鲜冷冻颈椎，每一标本依次制作成以下3种状态组：即正常对照组、Ⅱ型Hangman骨折模型组、椎间植骨+钢板内固定组。按以上顺序应用脊柱三维运动试验机和三维激光扫描仪测试每一状态C2/3节段的三维运动范围。 结果与结论：与正常对照组比较，Ⅱ型Hangman骨折模型组C2/3节段前屈、后伸、旋转及侧弯关节活动度均显著增大(P < 0.05)，钢板内固定+椎间植骨组旋转方向关节活动度显著增大(P < 0.05)；与Ⅱ型Hangman骨折模型组相比，钢板内固定+椎间植骨组C2/3节段前屈、后伸及侧弯关节活动度均显著减小(P < 0.05)。结果提示钢板置入内固定能够在前屈、后伸及侧弯方向恢复Ⅱ型Hangman骨折的稳定性，然而在旋转方向缺乏稳定作用，术后需辅以外固定以确保融合。     

不同前路中空加压螺纹钉内固定治疗Ⅱ型齿突骨折的生物力学评价★

背景: 目前前路中空加压螺钉固定被认为是治疗齿突骨折的较理想方法。 目的：比较不同前路内固定螺钉的生物力学特性。 设计、时间及地点：随机分组设计，对比观察，于2006-03/09在南方医科大学生物力学实验室完成。 材料：双头螺纹中空加压螺钉和单头螺纹中空加压螺钉均为钛合金材料，由苏州双羊医疗器械有限公司生产制作。 方法：20具防腐尸体头颈复合体(C0~C3)标本，甲醛浸泡不超过3个月，剔除其肌肉、韧带，取其枢椎标本，制成齿突Ⅱ型骨折模型。实验分为2组，双头螺纹螺钉组和单头螺纹螺钉组分别用双头螺纹和单头螺纹中空加压螺钉固定骨折，每组10例。 主要观察指标：测试两种螺钉的剪切刚度和最大拔出力。 结果：双头螺纹螺钉组的剪切刚度明显高于单头螺纹螺钉组(P < 0.01)。而最大拔出力差异无显著性意义(P > 0.05)。 结论：双头螺纹中空加压螺钉治疗齿突骨折具有更强的生物力学稳定性；对于骨质梳松者和手术操作引起钉道扩大的患者，应首选双头螺纹中空加压螺钉。     

髋臼前柱骨折钢板中内固定的最佳进针点*☆

背景：近年来切开复位内固定成为骨盆骨折和髋臼骨折的一种重要治疗手段,但是在内固定过程中有时会发生螺钉穿入关节内、损伤盆腔内重要血管或神经等严重并发症。 目的：测量髋臼前柱钢板内固定技术中螺钉的最佳进钉点、方向和长度。 材料：取成年男性半骨盆标本20个,由山东大学医学院解剖学教研室提供。 方法：分别测量20个半骨盆标本髋臼前、后缘到髂前下棘、髂耻隆起和耻骨结节的距离,确定和制作髋臼前柱系列断面,并测量各断面上各进钉点的安全进钉角度,将测量数据输入到SPSS 10.0软件进行统计学分析。 主要观察指标：髋臼前柱钢板内固定技术中螺钉的最佳进钉点、方向和长度。 结果：髋臼前缘到髂前下棘、髂耻隆起和耻骨结节的距离分别为(25.4±1.4),(11.8±0.7),(37.4±1.5) mm,后缘到髂前下棘和髂耻隆起的距离分别为(15.5±0.9),(29.1±1.6) mm。在各断面距离骨盆界线0.5 cm点、1.0 cm点和1.5 cm点上螺钉的安全进钉角度的最大值分别为(8.2±2.2)°,(14.9±3.4)°和(26.1±4.5)°。 结论：在前柱髋臼区使用钢板内固定时,可以采用3种方法避免螺钉穿入关节内。第1种方法是使用短螺钉,螺钉方向随意;第2种方法是使用长螺钉(长度5 cm)内紧贴骨盆界线进钉,方向平行于四方区;第3种方法为根据不同的进钉点选择不同的进钉角度和长度。     

定量解剖学观察髋臼前柱骨折螺钉内固定置入的力学特征

背景：近年来切开复位内固定成为骨盆骨折和髋臼骨折的一种重要治疗手段,但是在内固定过程中有时会发生螺钉穿入关节内、损伤盆腔内重要血管或神经等严重并发症。 目的：测量髋臼前柱骨折拉力螺钉内固定技术中螺钉的最佳进钉点、角度和长度。 设计、时间及地点：测量性实验,于2008-06/10在山东大学医学院解剖学教研室完成。 材料：取成年男性半骨盆标本20个,制作髋臼前柱系列断面。 方法：在单螺钉技术中,测量进钉点O与坐骨大切迹顶点Q之间的水平距离OP和垂直距离PQ的长度,测量螺钉长度。在双螺钉技术中,分别测量内侧螺钉的进钉点O1和外侧螺钉的进钉点O2与坐骨大切迹顶点Q之间的水平距离O1P1、O2P2和垂直距离P1Q、P2Q的长度,分别测量内侧螺钉和外侧螺钉的长度。测量螺钉矢状面的角度α和冠状面的角度β,将测量数据输入到SPSS 10.0软件进行统计学分析。 主要观察指标：髋臼前柱拉力螺钉技术中螺钉的进钉点、角度和长度。 结果：单螺钉技术：OP和PQ的长度分别为(23.5±2.2) mm和(16.8±1.6) mm,螺钉长度为(84.9±4.7) mm。双螺钉技术：O1P1和P1Q的长度分别为(26.3±2.3) mm和(13.6±1.4) mm,内侧螺钉的长度为(69.8±4.1) mm;O2P2长度(20.7±2.1) mm,P2Q长度(20.1±1.8) mm,外侧螺钉的长度(61.2±3.7) mm。α角为(123.4±4.1)°,β角为(62.2±5.8)°。 结论：单螺钉技术螺钉的进钉点位于坐骨大切迹顶点处垂直于后柱内侧缘向外17 mm,再平行于后柱内侧缘向上24 mm,长度约85 mm。双螺钉技术内侧螺钉的进钉点位于坐骨大切迹顶点处垂直于后柱内侧缘向外14 mm,再平行于后柱内侧缘向上26 mm,螺钉长度70 mm。外侧螺钉的进钉点位于坐骨大切迹顶点处垂直于后柱内侧缘向外20 mm,再平行于后柱内侧缘向上21 mm,螺钉长度61 mm。拉力螺钉与后柱内侧缘平行线所成的角度为123°左右,与后柱内侧缘平行线的垂线所成的角度为62°左右。螺钉位置一定要通过多角度、多方位的透视证实。     

Successful repair of esophageal perforation after anterior cervical fusion for cervical spine fracture

Esophageal injury after anterior cervical discectomy and fusion (ACDF) is a rare complication that can be life threatening. The sternocleidomastoid (SCM) pedicled muscle flap has emerged as an effective and versatile tool for selected esophageal perforations. The authors report their surgical experience in three patients with an esophageal perforation after ACDF, and the steps taken to achieve successful repair using a SCM muscle flap. All three patients underwent ACDF at another hospital. Postoperatively, patients complained of severe dysphagia, neck swelling, fever, and alimentary fluid leakage. They were later referred to the author’s hospital for diagnostic evaluation and surgical treatment of an esophageal perforation. Esophageal perforation was diagnosed on esophagoscopy and esophagography, and treated by primary closure using an SCM muscle flap. Postoperatively, all patients had a good result. Surgery-related complications occurred in one patient with dysfunction of the recurrent laryngeal nerve. This study shows that esophagoscopic diagnosis and surgical treatment using a SCM muscle flap is highly effective in patients with an esophageal perforation related to ACDF.     

The application of a zero-profile implant in anterior cervical discectomy and fusion

We analyzed the clinical efficacy of the Zero-P implant (Synthes GmbH Switzerland, Oberdorf, Switzerland) in the treatment of single level cervical spondylotic myelopathy. The clinical data of 47 patients with single level cervical spondylotic myelopathy were retrospectively analyzed. Twenty-two patients were treated with a Zero-P implant (Group A) and 25 with a titanium plate with cage (Group B) between January 2009 and September 2010. Operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and JOA recovery rate, dysphagia incidence and adjacent segment degeneration rate were measured. The mean operative time in Group A and Group B was 98.18 minutes and 105.4 minutes, respectively. The average intraoperative blood loss in Group A and Group B was 87.95 ml and 92.4 ml, respectively. There were no statistical differences in operation time and intraoperative blood loss between the two groups (p > 0.05). The JOA score was significantly improved in the two groups (p < 0.001), and the recovery rate was similar (60.86% for Group A versus 62.95% for Group B, p > 0.05). Dysphagia was experienced by one (4.5%) patient in Group A and eight (32%) patients in Group B, which was significantly different (p = 0.044). There was no statistical significance found in the adjacent level degeneration rates between Group A and Group B (p = 0.330). The Zero-P implant and traditional titanium plate with cage are effective treatments for single level cervical spondylotic myelopathy, but the Zero-P implant has a lower dysphagia incidence.     

Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy

The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries.     

Use of an integrated anterior cervical plate and cage device (PCB) in cervical anterior fusion

The aim of this study is to evaluate an integrated cage and plate device (the plate cage Benezech, PCB) filled with autogenous bone in anterior cervical discectomy and fusion. The fused segment height, lordosis, and fusion were assessed by postoperative radiographic examination at different intervals. Patients were evaluated using Odom’s criteria and the Short Form (SF)-36 Health Survey questionnaire. The mean follow-up duration was 4.1 years. Fusion was achieved in 90.0%, 96.0% and 100% of patients at 3 months, 6 months and at final visit, respectively. The fused segment height and lordosis were restored and maintained. Cage subsidence (3 mm) occurred at one level and settling was observed at three levels. An excellent-to-good result was achieved in 81.8% of patients. The data from the SF-36 questionnaire revealed significant postoperative improvement (p < 0.01) except for social function and mental health. This study suggests that patients instrumented with PCB can obtain good radiographic and clinical results and that PCB is a safe and effective device in cervical anterior fusion.     

不稳定肩胛颈骨折植入物与非植入物治疗的比较

背景：肩胛颈骨折治疗存在争议,部分学者认为保守治疗即可获得满意的临床效果;而另一部分学者认为需要钢板置入治疗。 目的：比较重建钢板置入治疗与保守治疗不稳定肩胛颈骨折的疗效。 方法：于2005-07/2009-12收治25例不稳定肩胛颈骨折患者,其中保守治疗13例,重建钢板置入内固定治疗12例。 结果与结论：25例获随访3~24个月。植入物组和非植入物组骨折愈合时间均为2~4个月,无明显区别。非植入物组Herscovici功能评分(8.46±3.20)分;优2例,良3例,可6例,差2例,优良率38.5%;正位X射线片上测量为盂极角(21.7±4.6)°。植入物组Herscovici功能评分(11.75±2.60)分;优5例,良6例,可1例,差0例,优良率91.7%;盂极角(38.8±2.9)°,各项指标两组比较,差异均有显著性意义(P < 0.05)。说明重建钢板置入治疗不稳定肩胛颈骨折可以重建肩关节稳定性,促进关节功能恢复,效果优于保守治疗。     

前路钢板加钛网融合金属置入物治疗颈椎骨折脱位23例：X射线及1年随访评价★

回顾性分析2005-01/2008-01解放军第309医院骨科收治的采用前路带锁钢板系统加钛质网笼内植骨融合置入治疗的23例外伤性颈椎骨折脱位患者，男16例，女7例；年龄25~65岁，平均41.9岁。评价前路带锁钢板系统加钛质网笼内植骨融合治疗颈椎骨折脱位的临床疗效及应用价值。以JOA评分系统分别评价患者置入前、置入后即刻、置入后随访情况，以评判手术减压效果；并分别摄置入前、置入后即刻、置入后随访X射线平片，以Cobb角测量融合节段的前凸(或后凸)，以D值(齿状突到C7后下缘连线与C4后下缘垂直距离)评价颈椎的前凸(或后凸)，评判重建和维持颈椎生理曲度的疗效。23例患者均获得随访，随访时间1~3年，平均20.5个月。所有病例均获临床稳定，置入前JOA评分、Cobb角及D值与置入后即刻，置入后随访相比，差异均有显著性意义(P < 0.05)；置入后即刻与置入后随访之Cobb角及D值差异无显著性意义(P > 0.05)，但置入后随访之JOA评分较置入后即刻仍有改善(P < 0.05)。随访1年以上平均改善率为63%。提示应用前路带锁钢板系统加钛质网笼内植骨融合治疗颈椎骨折脱位，在恢复和维持颈椎生理曲度方面疗效满意。     

Comparison of perioperative complications following staged versus one-day anterior and posterior cervical decompression and fusion crossing the cervico-thoracic junction

IntroductionMultilevel cervical pathology may be treated via combined anterior cervical decompression and fusion (ACDF) followed by posterior spinal instrumented fusion (PSIF) crossing the cervico-thoracic junction.The purpose of the study was to compare perioperative complication rates following staged versus same day ACDF combined with PSIF crossing the cervico-thoracic junction.Material and methodsA retrospective review of consecutive patients undergoing ACDF followed by PSIF crossing the cervico-thoracic junction at a single institution was performed.Patients underwent either same day (group A) or staged with one week interval surgeries (group B). The minimum follow-up was 12 months.ResultsThirty-five patients (14 females and 21 males) were analyzed. The average age was 60 years (37–82 years). There were 12 patients in group A and 23 in group B. Twenty-eight complications noted in 14 patients (40%) included: dysphagia in 13 (37%), dysphonia in 6 (17%), post-operative reintubation in 4 (11%), vocal cords paralysis, delirium, superficial incisional infection and cerebrospinal fluid leakage each in one case. Significant differences comparing group A vs. B were found in: the number of levels fused posteriorly (5 vs. 7; p = 0.002), total amount of intravenous fluids (3233 ml vs. 4683 ml; p = 0.03), length of hospital stay (10 vs. 18 days; p = 0.03) and transfusion of blood products (0 vs. 9 patients). Smoking and cervical myelopathy were the most important risk factors for perioperative complications regardless of the group.ConclusionsStaging anterior cervical decompression and fusion with posterior cervical instrumented fusion 1 week apart does not decrease the incidence of perioperative complications.     

Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis

Pseudarthrosis occurs after approximately 2–20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3–151) months after ACDF. Median age at index surgery was 51 (range: 33–67) years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0–10), and/or myeloradiculopathy. Patients with pseudarthrosis <12 months compared to >12 months after index surgery were older (p = 0.013), had more frequent preoperative neurological deficits (p = 0.064), and lower baseline VAS scores (p = 0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2–14) months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p = 0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study.