椎弓根螺钉技术在下颈椎不稳中的安全使用方法

目的探讨颈椎椎弓根技术在下颈椎疾病的安全使用方法。方法回顾性分析2001年10月-2006年3月76例下颈椎疾病行颈椎椎弓根固定患者,其中49例为颈椎骨折脱位, 23例为颈椎病,4例为椎管内肿瘤。患者术前均行X线和CT等检查,术中在C形臂X线监视下置钉,术后行X线和CT检查了解螺钉位置。结果76例螺钉均成功置入,术中无脊髓、椎动脉损伤。术后CT显示,342枚螺钉中有37枚(10.8%)螺钉穿破椎弓根,其中29枚螺钉穿破椎弓根外侧皮质,3枚螺钉穿破椎弓根上侧皮质,5枚螺钉穿破椎弓根下侧皮质。所有患者近期及远期随访未发现与椎弓根螺钉相关的神经血管及内脏器官损伤的并发症。有1枚螺钉断裂,但患者没有明显的临床症状,其余未发现螺钉松动或断钉及颈椎不稳症等。所有患者固定良好,并均已达骨性融合。术后随访脊髓神经功能均有不同程度改善。结论颈椎椎弓根固定提供了三柱的稳定和最坚强的后方固定,为了防止并发症的发生,熟悉颈椎椎弓根的解剖和手术操作技巧以及采用个体化综合置钉是决定手术成功的重要因素。     

寰枢椎后路椎弓根螺钉固定治疗C1-2不稳患者的围术期护理

总结27例寰枢椎后路椎弓根螺钉固定治疗C1-2不稳患者的围术期护理.上颈椎解剖结构特殊,手术难度大、风险高,术前做好心理护理,耐心讲解手术治疗的意义和预期效果;做好牵引护理,让患者及家属观看牵引治疗实景,牵引时在患者颈后横放1条约3～4 cm高的条形卷巾使颈椎保持在正常的前凸位;术前做好沟通和呼吸咳嗽训练,指导患者进行深呼吸、有效咳嗽和吹气球练习.术后采用"轴型滚动式"翻身法,2～3 d指导患者在颈托固定保护下坐起或下地活动;严密观察生命体征,防止因术后出血、水肿波及延髓,引起循环、呼吸中枢功能障碍,警惕呼吸睡眠暂停综合征的发生;严密观察患者四肢感觉及运动情况,防止出现脊髓损伤、水肿等并发症;严密观察切口与引流管情况,防止出现脑脊液漏、切口感染;做好出院指导.本组患者术后X线片及CT显示寰枢椎侧块和椎弓根螺钉位置全部良好,未出现并发症,随访1年均已达到骨性融合.     

枢椎椎板螺钉治疗上颈椎不稳的临床研究

目的探讨枢椎椎板螺钉技术的临床应用和适应证。方法2004年10月至2008年12月,采用后路枢椎椎板螺钉技术治疗上颈椎不稳35例,男19例,女16例;年龄23～73岁,平均45岁。AndersonⅡ型和Ⅲ型齿突骨折19例,寰椎横韧带断裂1例,先天性游离齿突并寰枢椎不稳2例,寰椎骨折合并寰枢椎不稳7例,不典型Hangman骨折并C2-3不稳1例,C2-3创伤性不稳5例。患者均采用颈椎后路Vertex钉棒系统固定。结果35例患者共置入枢椎椎板螺钉68枚,术中无一例发生脊髓和椎动脉损伤。患者均获得随访,随访时间6个月～4年,平均25.5个月。随访时X线片均未见明显颈椎不稳、内固定失败及螺钉松动退出。11例患者螺钉穿出椎板背侧,但无症状出现。结论枢椎后路经椎板螺钉技术固定牢固,操作简单,相对安全,特别适用于C2椎弓根发育异常或骨折不能采用椎弓跟固定的患者。     

手法复位后路单节段椎弓根螺钉固定植骨融合治疗胸腰椎骨折

对于胸腰椎骨折,目前多采用后路短节段椎弓根螺钉固定。该方法固定可靠,操作简单,但术中暴露广泛,需固定融合2个节段[1]。因此,近年来后路单节段椎弓根螺钉固定技术逐渐受到重视[2-3]。由于单节段椎弓根螺钉固定中伤椎只有椎弓根和一侧终板是完整的,应避免大角度器械复位和大距离的撑     

颈椎经关节椎弓根螺钉固定与标准椎弓根螺钉固定的生物力学比较

Objective To compare biomechanical pullout strength of cervical transfacet pedicle screws to that of standard pedicle screws. Methods Ten fresh human cadaveric cervical spines were harvested. On one side, transfacet pedicle screws were placed at the C3,4, C5,6, and C7T1 levels. On the other side, pedicle screws were, placed at the C3, C5, and C7 levels. The screw insertion technique at each level was randomized for right or left. The starting point for the transfacet pedicle screw insertion was about located at the midpoint of the inferolateral quadrant of the lateral mass and the direction of the screw was about 50° caudally in the sagittal plane and about 45° medially in the axial plane. Screws were placed across the facet joint and the pedicle into the body of the caudal vertebra. The entry points for pedicle screw was located at the midpoint of the superolateral quadrant of the lateral mass and the direction of the screw was about 45° toward the midline in the transverse plane and toward the upper third of the vertebral body in the sagittal plane. The pedicle screws were oriented along the axis of the pedicle in an effort to avoid violations of the cortical wall. All the screw insertions were based on direct observation and the CT scan on the pedicles. After screw placement, axial pullout testing was performed. Results The mean pullout strength for the transfacet pedicle screws was (694±42) N. This compares with (670±36) N for the pedicle screws (P< 0.05). The greatest difference at a single level in pullout strength was observed at the C5,6 level, with a mean difference of 38 N. Conclusion Transfacet pedicle screws exhibited statistically greater pullout strength to pedicle screws. At each level the transfacet pedicle screws exhibited greater pullout strength than the pedicle screws. Posterior transarticular pedicle screw fixation in the cervical spine affords an alternative to standard screw placement for plate fixation and cervical stabilization.     

Anatomic comparison of transarticular screws with latera mass screws in cervical vertebrae

Objective： To compare the potential incidence of nerve root （ventral and dorsal ramus） injury caused by cervical transarticular screws and Roy-Camille lateral mass screws. Methods ： Insertion techniques with Klekamp transarticular screws and Roy-Camille lateral mass screws were respectively performed in this study. Each technique involved four specimens and 40 screws, which were inserted from C3 to C7. And 20-mm-long screws were used to overpenetrate the ventral cortex. The anterolateral aspect of the cervical spine was carefully dissected to allow observation of the screw-ramus relationship. Results ： The overall percentage of nerve invasion was significantly lower with Klekamp （45%） technique than with Roy-Camille （ 85 %） technique （ P 〈 0.05 ）. The largest percentage of nerve invasion for Klekamp transarticular screws was found at the dorsal ramus （25 % ）, followed by the ventral ramus （ 15 % ） and the bifurcation of the ventral dorsal ramus （ 5 % ）. The largest percentage of nerve invasion for Roy-Camille lateral mass screws was found at the ventral ramus （80 % ）. Conclusion ： The potential risk of nerve root invasion is lower with Klekamp transarticular screws than with Roy Camille lateral mass screws.     

下颈椎关节突关节与椎体后缘关系的影像学研究

目的：研究探讨下颈椎关节突关节前缘与椎体后缘的位置关系，为临床行下颈椎经关节螺钉植入时评价进钉深度提供参考。方法：选取无明显下颈椎畸形的标准颈椎侧位X线片100张，下颈椎标准CT平扫片50张，测量下颈椎关节突关节顶点、中部、基底部前缘与椎体后缘的距离（分别记为HS，HM，HI），椎体后缘之前为负、之后为正。并对测量数据行统计学分析。结果：所有关节突关节前缘距离、椎体后缘的距离从顶点到基底部逐渐减小（HS〉HM〉HI）。C。关节突关节前缘大多位于椎体后缘之前（HS，HM，HI均为负值）；C4.5C5.6关节突关节前缘逐渐后移；Co，，关节突关节前缘均位于椎体后缘之后（HS，HM，HI均为正值）。下颈椎关节突关节顶点前缘与椎体后缘的距离HS从C。到C6，7逐渐增大，C3．4为（0±0．25）mm，C4．5为（2．03±0．47）mm，C5．6为（2．45±0．56）mm，C6．7为（2．91±1．05）mm；下颈椎关节突关节中部前缘与椎体后缘的距离HM从C3.4到C6.7逐渐增大，C3.4为（-1．57±0.53）mm,C4.5为（O．50±0．26）mm，C5．6为（0．56±0．36）mm，C6．7为（1．54±0．39）mm；下颈椎关节突关节基底部前缘与椎体后缘的距离HI从C3.4到C6.7逐渐增大，C3.4为（-2．03±0．40）mm，C4．5为（0±0．30）mm，C5，6为（0．50±0．44）mm，C6．7为（1．08±0．70）mm。结论：在行下颈椎经关节螺钉固定时，螺钉的头部在C3.4应位于相应榷体后缘前方0～2mm，C4.5应位于相应椎体后缘之后0-2mm，C5.6应位于相应椎体后缘之后0．5-2．5him，C6.7应位于相应椎体后缘之后1～3mm。下颈椎关节突关节前缘与椎体后缘关系的确立，可为临床工作中下颈椎经关节螺钉植入时判断进钉深度提供参考。     

颈椎前后入路一期手术治疗颈椎骨折脱位的护理

总结20例一期颈椎前后路联合手术治疗颈椎骨折脱位的护理.认为术前注重心理护理和气管推移训练,术后密切观察生命体征、神经功能恢复、引流液量及颜色、切口愈合情况,并重视早期的功能锻炼.20例患者经5月～4年随访,术前症状均有不同程度缓解.