侧块钢板螺钉系统在颈椎后路手术中的应用

目的 探讨侧块钢板螺钉系统在颈椎后路手术中应用的临床经验。方法 对1999年2月－2000年3月间共36例行侧块钢板内固定的患者进行回顾分析。29例（80．6％）获得随访，平均随访时间8个月（4－15个月）。29例患者中颈椎病（3节及3节段以上椎间盘突出）20例，黄韧带骨化症（OYL）1例，后纵韧带骨化症（OPLL）2例，颈椎骨折脱位6例。手术时采取坐位，病变节段行全椎板切除减压，保留关节突。钢板螺钉固定于侧块（即关节突），同时关节突间植骨融合。结果 29例患者共植入124枚螺钉，平均每位患者4．3枚。颈痛明显改善者为18例（20例术前存在颈痛）占90％。术后3－6月X线随访，27例患者关节突间见骨小梁生成，融合率93％。4例患者路侧块钢板螺钉系统能提供较稳定的固定，有效改善颈痛。钢板螺钉松动与神经根损伤是较严重的并发症。只要严格掌握手术适应证与安装技术，颈椎后路钢板固定是治疗颈椎不稳的一种十分有效的方法。

Posterior Lateral Mass Plate Fixation in the Management of Subaxial Cervical Spine in Consecutive Patients

Purpose To study the clinical experience of applying posterior lateral mass plates. Methods Records of 36 consecutive patients who underwent total laminectomy,posterior lateral mass plate fixation and fusion with bone graft were retrospectively analyzed.29 cases were followed up.The average follow up was 8 months (range 4 to 15 months).The most common indications for internal fixation were instability after multi level laminectomy ( n=23 ) and post traumatic instability ( n=6 ).The former included cervical spondylotic myelopathy,ossification of yellow ligament (OYL),ossification of posterior longitudinal ligament (OPLL).The latter included fracture dislocation.Patients were immobilized postoperatively in a collar. Results 124 screws were inserted in the cervical spine (average,4.3 screws per patient).Neck pain was improved in 18 (90%) of 20 patients.Solid arthrodesis was achieved in 27 (93%) of 29 patients.Complications associated with placement of the screws included screw loosening in 4 cases (3.2%),and nerve root injury in 4 (13.8%) of 29 patients. Conclusions Posterior lateral mass plating is highly effective.It can provide stable fixation and can improve the neck pain.Plate failure was related with faulty screw placement,including screw loosing and nerve root injury.