Cobra枕颈内固定系统结合Halo-vest治疗颅颈交界区畸形效果

背景：枕颈部后路融合能够解除脊髓压迫并能让失稳枕颈部重新早期获得稳定。解剖型设计的Cobra系统对失稳的枕颈区提供坚强的内固定,结合Halo-vest外固定,具有固定,复位,利于植骨融合的作用。目的：观察Cobra枕颈内固定系统结合Halo-vest在治疗颅颈交界区畸形枕颈融合术中的应用,并评价其临床疗效。方法：对34例颅颈交界区畸形患者行术前术中牵引复位固定,固定后依患者耐受情况决定保留或去除Halo-vest等针对性治疗。根据JOA评分对患者神经功能恢复进行评估;根据尹庆水等制定的方法计算神经功能改善率。内固定后3,6,12,24个月摄颈椎正侧位X射线平片、CT及三维重建,以判断内固定和植骨融合情况,对部分患者同时行MRI检查以明确颈脊髓减压情况。结果与结论：34例患者均获随访,随访时间7~29个月。内固定后未出现脊髓症状加重病例。内固定前JOA评分平均8.2分,内固定后平均14.8分;脊髓功能平均改善率为75%;1例并发脑梗死死亡。内固定后6个月复查,2例患者植骨块部分吸收骨不连,2例患者枕骨板螺钉出现松动,1例螺钉脱出,1例切口不愈合。10例患者术后继续Halo-vest外固定,并于内固定后三四个月拆除;其余患者佩戴颈托至植骨完全愈合。提示Cobra枕颈内固定具有良好的生物力学稳定性,配合Halo-vest便于术中固定和复位,适用于颅颈交界区畸形的治疗。

Effect of cobra internal fixation system combined with halo-vest on treatment of the craniocervical malformation

BACKGROUND:Craniocervical posterior fusion can decompress the spinal cord and obtain the early stability for the instability occipitocervical fusion. The anatomic design of Cobra system can provid strongly internal fixation for this instability fusion and it is beneficial for fixation, reduction and bone graft fusion with the Halo-vest external fixation.OBJECTIVE:To evaluate the clinical application of Cobra internal fixation system with Halo-vest in craniocervical fusion surgery for craniocervical region malformation patients. METHODS:Thirty-four cases of craniocervical region malformation underwent craniocervical fusion using Cobra internal fixation system and with a specific therapy used Halo-vest according to the actual situation. The JOA17 spinal cord function evaluation standard was used for evaluation of the treatment effect. The neurologic recovery rate was calculated by the method established by Yin Qing-shui. At 3, 6, 12, and 24 months after the internal fixation, two-plane roentgenograms, CT and 3D reconstruction could be made to judge the internal fixation and bone grafting fusion situation, some patient also did MRI to clarify the spinal cord decompression.RESULT AND CONCLUSION:All of the patients were followed up for 7-29 months. There were no aggravations of the symptoms of spinal cord compression. The preoperative average spinal function was 8.2 and postoperative average was 14.8, respectively. The overall mean improvement was 75%. One patient died of cerebral infarction postoperatively. At the sixth month of follow-up, there were two cases with bone graft nonunions and absorption, two cases with the loosed occiput plate bolt, one case with the pulled out screws, one case with a nonhealing incision. The Halo-vest was used in ten cases for 3 to 4 months postoperatively. Other cases wore a cervical collar until the bone grafts were fused completely. It is suggested that Cobra internal fixation system offers a good biomechanical stability for craniocervical region fixation. It’s convenient for reduction and fixation during the operation along with the Halo-vest, and suitable for the treatment of craniocervical region malformation.