三种置钉方法在下颈椎经椎弓根螺钉置入过程中的比较

背景：目前各种下颈椎椎弓根置钉方法的准确率报道不一,特别是国内常用的椎板部分切除置钉法、Abumi法、管道疏通法缺乏比较。 目的：探讨下颈椎(C3~7)经椎弓根螺钉内固定的可行性,比较椎板部分切除置钉法、Abumi法、管道疏通法在置钉满意率、出血量、置钉时间、并发症等方面的差异。 方法：选择60例需颈后路经椎弓根螺钉内固定治疗的下颈椎疾患病例,随机分成3组,各置入椎弓根螺钉80枚,分别采用椎板部分切除置钉法、Abumi法及管道疏通法。术中计算各方法置钉时间、出血量;出院前观察置钉满意率及在颈椎椎弓根四壁损伤例数的构成比;比较C3~7每一节段的椎弓根外侧壁损伤发生率。 结果与结论：椎板部分切除组、Abumi组及管道疏通组置钉时间依次递减(P < 0.05),置钉满意率依次递增(P < 0.05)。3组间置钉出血量及颈椎椎弓根四壁损伤例数的构成比差异无显著性意义(P > 0.05),椎弓根损伤好发生于外壁。C4、C5节段外壁损伤发生率明显高于C3、C6、C7。提示管道疏通法在经颈后路椎弓根螺钉内固定常规置钉法中优势明显。

A comparative study on pedicle screw internal fixation to the lower cervical vertebra by three screw place methods

BACKGROUND:Nowadays there are so many screw place methods in lower cervical vertebra. But they have different accuracy. There was no comparative study on the pedicle screw internal fixation in lower cervical vertebra by three screw place methods such as vertebral plate partial resection screw place method, Abumi place screw method and pipeline dredge method. OBJECTIVE:To explore the feasibility of the pedicle screw internal fixation in lower cervical vertebra (C3-7), and to compare the differences in screw satisfaction rate, blood loss, screw placing time, complications among vertebral plate partial resection screw place method, Abumi screw place method, and pipeline dredge method.  METHODS:Totally 60 patients with lower cervical spine disease who needed the pedicle screw internal fixation through cervical posterior approach were chosen and divided into three groups each with 80 pedicle screws by vertebral plate partial resection place screw method (group A), Abumi screw place method (group B), and pipeline dredge method (group C). Intraoperative bleeding and time to place screw were calculated. The satisfaction rate and the constituent ratio in all sides of pedicle injury were observed before discharge. The incidence of lateral wall injury from C3 to C7 was compared. RESULTS AND CONCLUSION: The time to place screw was progressively decreased in groups A, B and C (P < 0.05). There was no significant difference in the intraoperative bleeding and the constituent ratio among three groups (P > 0.05). The incidence of lateral wall injury in C4-5 was higher than that in C3, C6-7. It is indicated that pipeline dredge method is superior to vertebral plate partial resection screw place method and Abumi screw place method in posterior pedicle screw fixation.