颈椎椎弓根螺钉内固定术中并发症及其对策

目的：探讨颈椎椎弓根螺钉固定技术常见并发症及其处理方法。方法：应用Axis内固定系统（美国枢法模公司）对69例颈椎病患者进行经后路椎弓根内固定术，术中清晰显露颈椎侧块和突间关节，用直径3．2mm高速球形磨钻去除侧块外上象限处骨皮质，然后用直径2．0mm的手锥沿椎弓根事先确定的方向轻轻钻入，使其自然置入，深约2．0～2．5cm。确定无误后，则安置Axis钛板和置入长度合适的椎弓根螺钉，完毕后用C形臂X线机作双斜位透视。结果：从C3到C7，术中植入椎弓根螺钉314枚，其中21枚钉初次置入后感觉松动，经校正后二次置入成功，17枚钉道钻孔后出血较多，但及时处理后出血停止并无不良结果，其余螺钉置钉一次成功，未出现并发症。术后检查有28枚螺钉穿出椎弓根，6枚螺钉穿破椎弓根上侧皮质，3枚螺钉穿破椎弓根下侧皮质，12枚螺钉穿破椎弓根外侧皮质，7枚螺钉穿破椎弓根内侧皮质。随访未发现与螺钉置入穿破椎弓根皮质相关的神经血管损伤问题。结论：手术前充分了解每个患者颈椎椎弓根影像学解剖结构，术中仔细按原则操作，正确处理则会明显减少术中及术后并发症的发生。

Complications of cervical pedicle screw fixation and its managements

Objective: To study complications of cervical pedic le screw fixation and to find its manag ement. Methods: Sixty-nine patients with cervical spine dixorders o r furactures treated with 314 pedicle sc rews were reviewed.Operation procedure w as hereinafter.Hand cones w ith 2.0 mm diameter were drilled along p re-decided route and its depth was 2.0 to 2.5 cm.Axis Tit an plates and cervical pedicle screws of s uitable length were put into and its sit e was determined by X-ray examination. Results: From C₃ to C₇,314 cervical pedicle scr ew s were planted.Because of loose plant,21 screws were put in for the second time. Bleeding of 80 to 150 ml in 5 minutes fr om the pedicle hole was found in 17 case s.Postoperative examination showed that 28 screws penetrated pedicle of vertebra ,within them,6 penetrated upper cortex o f cervical p edicle,3 through lower cortex,12 externa l cortex and 7 interior cortex.Solid fusi on was achieved in 49 patients and no fusi on was found because the time of folow-u p was shorther(<6 months).C onclusion:Preoperative car eful evaluation of the morphology of the cervical pedicles and meticulous techniq ues of screw placement are essential in avoiding complications in a step-wise.