颈椎后前路减压内固定术翻修颈椎前路内固定失效的临床研究

目的:探讨颈椎后前路减压内固定术翻修颈椎前路内固定失效的临床疗效及并发症预防。方法:2008年1月至2011年12月,采用颈椎后前路联合减压内固定手术治疗颈椎前路内固定失效17例,男12例,女5例;年龄26~68岁,平均44.1岁。其中内固定下位螺钉松动6例,上位螺钉松动5例,钛网沉陷3例,上位螺钉断裂2例,下位螺钉断裂1例。通过影像学观察患者的植骨融合情况,采用改良JOA(Japanese Orthopaedic Association Scores)17分评分法进行临床功能评价。结果:所有翻修手术顺利完成。1例术前凝血功能欠佳患者术后血肿,出现神经症状,予急诊血肿清除,输注新鲜冰冻血浆后,神经症状基本恢复。所有患者获得随访,时间6~38个月,平均(22.4±10.0)个月。术后2周、3个月、末次随访时JOA评分分别为13.1±1.6、13.4±1.6、14.2±1.5,均较术前明显改善。所有患者翻修后保留或更换的内固定物位置良好,在术后10个月时显示骨性融合,平均融合时间6个月。结论:采用后前路联合减压内固定翻修颈前路内固定失效安全性高,减压彻底,能够稳定减压节段,维持颈椎曲度,重建三柱稳定,可用于颈椎前路内固定失效患者的治疗。

Clinical study of cervical anterior and posterior decompression and internal fixation in the revision of anterior cervical fixation failure

Objective: To investigate the clinical effects and prevent the complications of posterior and anterior decompression and internal fixation in the revision of cervical anterior internal fixation failure. Methods: From 2008 January to 2011 December,17 patients with cervical anterior internal fixation failure were treated with posterior and anterior decompression and internal fixation. There were 12 males and 5 females,aged from 26 to 68 years old with an average of 44.1 years. The lower screw loosening was found in 6 cases,the upper screw loosening in 5 cases,titanium mesh caving in 3 cases,the upper screw breakage in 2 cases,the lower screw breakage in 1 case. Informations of bone fusion were observed by X ray,CT,MRI. Clinical effects were evaluated by modified JOA score. Results: All the revision operations were successfully completed. One case with poor blood coagulation function before operation resulted in postoperative hematoma and occurred neurological symptoms;after hematoma removal and fresh frozen plasma infusion later,neurological symptoms of the patient disappeared. All patients were followed up from 6 to 38 months with an average of(22.4±10.0) months. Postoperative at 2 weeks,3 months,and final follow up,JOA score had obviously improved and respectively was 13.1±1.6,13.4±1.6,14.2±1.5. All internal fixation locations were good after revision,and obtained bone fusion at 10 months after operation,with an average fusion time of 6 months. Conclusion: The combined posterior and anterior decompression and internal fixation in the revision of cervical anterior internal fixation failure is safe,can achieve thoroughly decompression,maintain the cervical curvature,reconstruct the three column stability,and it may be used for the patients of cervical anterior fixation failure.