颈椎后路经关节螺钉钢板内固定术在下颈椎骨折脱位中的应用

目的探讨后路经关节螺钉钢板固定在下颈椎骨折脱位中的临床应用。方法2003年2月-2006年5月,对22例严重下颈椎骨折脱位采用后路经关节螺钉Axis钢板固定10例;后路联合前路减压、植骨融合、Orion钢板固定12例,共置入78枚经关节螺钉。术中运用Klek- amp经关节螺钉技术,以侧块中心点内侧1 mm为进钉点,进钉角度在矢状面上尾倾40°,在冠状面上外倾20°,行四层皮质固定。结果22例患者均获得随访,时间3个月～3年,平均15个月。术中所有螺钉均成功置入,1例患者术后第3天出现C7单侧神经根刺激症状,未予特殊处理,3个月后症状消失。没有出现椎动脉和脊髓损伤等其他置钉相关并发症。发现1例螺钉松动部分脱出,经加强颈托制动,术后3.5个月仍获得融合。其余患者均融合成功。结论下颈椎后路经关节螺钉钢板固定如使用得当,固定可靠、操作简单、相对安全。经关节螺钉钢板置入前,必须行脱位复位和小关节间植骨。     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

枢椎棘突螺钉单侧应用联合对侧椎弓根螺钉固定的有限元分析

目的分析枢椎棘突螺钉单侧应用联合对侧椎弓根螺钉固定在寰枢和枕颈固定中的生物力学稳定性。方法构建正常枢椎解剖、椎板薄和椎动脉变异椎弓根细小3种不同解剖状态下的完整上部颈椎有限元模型作为完整模型组,然后分别模拟齿状突骨折进行寰枢固定和寰椎骨折进行枕颈固定。在寰枢固定中,比较单侧枢椎棘突螺钉+对侧椎弓根螺钉+双侧寰椎侧块螺钉固定组(棘突螺钉组)和枢椎双侧椎弓根螺钉+双侧寰椎侧块螺钉固定组(椎弓根螺钉组);在枕颈固定中,比较单侧枢椎棘突螺钉+对侧椎弓根螺钉+枕骨螺钉固定组(棘突螺钉组)和枢椎双侧椎弓根螺钉+枕骨螺钉固定组(椎弓根螺钉组)。枢椎棘突螺钉分别测试水平、斜向、垂直置钉3种不同的固定技术。模拟颈椎运动,测量枕颈的屈伸、侧屈、旋转的关节活动范围(ROM)。结果在寰枢和枕颈固定中,棘突螺钉组和椎弓根螺钉组的C1~C2屈伸、侧屈、旋转ROM均较完整模型组均明显下降。在寰枢固定中棘突螺钉组C0~C2屈伸、侧屈、旋转的ROM大于椎弓根螺钉组;在枕颈固定中,棘突螺钉组C1~C2侧屈的ROM大于椎弓根螺钉组,棘突螺钉组的C0~C2旋转的ROM大于椎弓根螺钉组。枢椎棘突螺钉分别测试水平、斜向、垂直固定间有差异,但不明显。结论在寰枢和枕颈固定中,枢椎双侧椎弓根螺钉固定和枢椎单侧棘突螺钉联合对侧椎弓根螺钉组合式固定方法均具有良好的稳定性。在寰枢固定中,相对于枢椎棘突螺钉组合式固定,枢椎双侧椎弓根螺钉固定具有更好的寰枢稳定性。在枕颈固定中,枢椎双侧椎弓根螺钉固定在侧屈和旋转活动上较枢椎棘突螺钉组合式固定稳定性更好。枢椎三种棘突螺钉置钉技术间的稳定性差异并不明显。     

后外侧入路空心钉内固定治疗下胫腓后韧带止点撕脱后踝骨折

目的探讨后外侧入路空心钉内固定治疗下胫腓后韧带止点撕脱后踝骨折的疗效。方法采用后外侧入路空心钉内固定治疗26例三踝骨折中下胫腓后韧带止点撕脱后踝骨折,先行内、外踝骨折内固定,再行后踝骨折固定。结果本组均获平均15(10~24)个月随访,未出现切口感染、皮肤坏死等并发症。术后随访X线片未见内固定失败、断裂。踝关节骨折均于术后3~4个月愈合,平均3.5个月。结论后外侧入路空心钉内固定治疗下胫腓后韧带止点撕脱后踝骨折操作方便、复位精确、固定可靠,值得进一步推广。     

下颈椎经关节螺钉钢板固定的生物力学研究

目的:研究下颈椎单独经关节螺钉固定与经关节螺钉钢板固定的三维稳定性之间的差异。方法:12具新鲜人体颈椎标本,制成C4,5、C5,6节段三柱损伤模型。随机选取6具标本在C4,5、C5,6行单独经关节螺钉固定,另6具标本在C4,5、C5,6行经关节螺钉钢板固定。在非限制性和非破坏性的试验条件下测试它们在前屈、后伸、左右侧弯和轴向旋转运动状态的稳定性,分别测试标本损伤模型制作前完整标本组(A组)、单独经关节螺钉固定组(B组)和螺钉钢板组(C组)3组数据。结果:单独经关节螺钉固定组和经关节螺钉钢板固定组在各方向的运动范围(ROM)和中性区(NZ)的均数均小于完整标本组,差异有统计学意义(P0.05)。经关节螺钉钢板固定在前屈运动中的ROM和NZ与单独经关节螺钉固定比较,差异无统计学意义(P0.05);在后伸、左右侧弯和轴向旋转运动中,经关节螺钉钢板固定的稳定性优于单独经关节螺钉固定,差异有统计学意义(P0.05)。结论:下颈椎经关节螺钉钢板固定的稳定性优于单独经关节螺钉固定,在使用下颈椎经关节螺钉时,相对于单独螺钉固定,建议以螺钉钢板形式固定。     

颈椎后路经关节内固定技术的最新进展

创伤、肿瘤及医源性骨性结构破坏等因素均可引起颈椎不稳,往往需要颈椎后路的固定和融合。颈椎后路经关节内固定技术包括经寰枕关节螺钉、经寰枢关节螺钉及下颈椎经关节内固定技术等。经寰枢关节螺钉固定已被广泛研究,而经寰枕关节螺钉和下颈椎经关节内固定技术至今未见广泛应用。     

枢椎经椎板螺钉固定的研究进展

椎(C2)螺钉无论是对于寰枢融合还是在下颈椎固定中均提供着重要的稳定性.目前临床常用的C2固定技术包括2椎弓根螺钉、侧块螺钉、经1/2关节螺钉和经2/3关节螺钉,以上技术均有着损伤椎动脉的风险.2004年Wright[1]首次提出2经椎板螺钉固定技术,并进行了10例临床应用,取得了良好的临床疗效.尽管2经椎板螺钉固定有其优点,但至今仍没有得到广泛的应用.     

颈椎一期前后路手术治疗颈椎骨折脱位患者的护理

严重创伤引起的下颈椎骨折脱位,往往需要颈椎固定和融合.一期前后路联合手术是目前治疗颈椎三柱损伤的有效方法之一.该手术包括前路行病变椎体次全切除,椎管减压,植骨融合,后路侧块螺钉和椎弓根螺钉固定.     

枢椎后路峡部螺钉固定的相关影像学测量

目的：通过CT测量探讨枢椎峡部螺钉固定技术的安全性和可行性。方法：收集2016年1月至2019年12月进行全颈椎CT检查的137例结构完整的上颈椎CT数据,其中男71例,女66例;年龄22~65（41.8±17.4）岁。通过Mimics19.0软件测量峡部螺钉技术相关的解剖学数据,包括峡部宽度、峡部垂直长度、峡部垂直高度、峡部螺钉通道长度、峡部螺钉通道头倾角度。并分析各项指标之间的相关性。结果：枢椎峡部宽度（9.05±1.63） mm,垂直长度（11.21±1.43） mm,垂直高度（17.53±2.93） mm。螺钉通道长度为（19.07±3.20） mm。峡部螺钉通道长度>14 mm的占94.53%,14~16 mm的占82.12%,16~18 mm的占63.14%,18~20 mm的占39.78%。螺钉通道的头倾角度为30°~68°,平均（46.06±8.06）°。螺钉通道长度和头倾角度呈高度正相关（r=0.965,P=0.000）。峡部垂直长度和螺钉通道长度,峡部垂直长度和螺钉的头倾角度之间都呈轻度正相关（r=0.240,P=0.000;r=0.163,P=0.007）。峡部宽度和螺钉通道长度,峡部宽度和螺钉通道的头倾角度之间都呈中度负相关（r=-0.333,P=0.000;r=-0.380,P=0.000）。结论：进行枢椎后路峡部螺钉固定安全、可靠,比枢椎后路椎弓根螺钉固定具有更大的适用范围,可以作为椎弓根螺钉的替代选择。     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.