徒手经寰枢椎椎弓根植钉固定的X线片和CT片个性化设计

目的 探讨利用X线片和CT片,徒手行寰枢椎椎弓根植钉固定,制定简便、实用的个性化手术方案,提高植钉的一次成功率.方法 2002年1月-2006年9月,于术前通过图像储存传输系统,采用自行设计的X线片和CT片个性化定位方案,利用自制的寰枢椎定位导向器,徒手对31例患者124枚寰枢椎椎弓根行经椎弓根固定手术.其中男18例,女13例;年龄23～61岁,平均43.5岁.Ⅱ型陈旧性齿状突骨折16例,齿状突不连7例,横韧带损伤8例.测量寰椎椎弓根进钉点左侧(19.93±1.32)mm,右侧(19.164±1.30)mm,寰椎椎弓根向内侧进钉角度左侧(23.72±2.09)°,右侧(23.35±1.91).;寰椎向头侧进钉角度(9.00±1.20)°.枢椎椎弓根进钉点左侧(13.14±0.82)mm,右侧(13.85±0.79)mm;枢椎椎弓根向内侧进钉角度左侧(24.52±1.26)°,右侧(20.42±1.42)°;枢椎向头侧进钉角度(25.00±3.00)°.结果 2例术后出现枕大神经痛,经对症治疗1个月后痊愈2例螺钉穿破寰椎左侧椎弓根外侧壁,未发现脊髓、椎动脉损伤.术后1 d,所有患者x线片示寰椎完全复位,枢椎齿状突骨折处对位良好.CT片示螺钉与椎动脉及脊髓位置关系良好.随访时间9个月～5年4个月,平均10.5个月,均获得骨性融合,未发现钉板断裂.按JOA评分标准,优16例,良12例,可2例,差1例,优良率90.32%.结论 X线片和CT片个性化设计方案及临床应用,设计简便、程序简化、个性化强,对寰枢椎椎弓根固定手术的实际操作有良好的指导意义.

CLINICAL APPLICATION AND PERSONAL X-RAY FILM AND CT DESIGN OF SCREW-PLATE SYSTEM BY PEDICLE OF ATLANTO-AXIS MANIPULATIVELY

OBJECTIVE: To study project of simplicity and utility for screw-plate system by pedicle of atlanto-axis manipulatively hand by X-ray film and CT to prove the one success rate of putting screws. METHODS: Formulate personal program was used in operation by image save transmission of X-ray film and CT during January 2002 and September 2006 in 31 patients. There were 18 males and 13 femals, aged from 23 to 61 years old withan average age of 43.5 years. Putting screw points by pedicle of atlas were measured: left (19.93 +/- 1.32) mm, right (19.16 +/- 1.30) mm; putting screw obliquity angle to inside by pedicle of atlas: left (23.72 +/- 2.09) degrees, right (23.35 +/- 1.91) degrees; putting screw obliquity angle to side of head by pedicle of atlas: (9.00 +/- 1.20) degrees. Screw points by pedicle of axis: left (13.14 +/- 0.82) mm right (13.85 +/- 0.79) mm; putting screw obliquity angle to inside by pedicle of axis: left (24.52 +/- 1.26) degrees, right (20.42 +/- 1.42) degrees; putting screw obliquity angle to side of head by pedicle of axis: (25.00 +/- 3.00) degrees. The domestic location toward speculum was employed in operation and putting screw points and angles were formulated by X-CT program. The pedicle screws of suitable diameter and length were of exception and screws into pedicle of atlanto-axis were put by hand. RESULTS: Pain of the greater occipital nerve occurred in 2 patients after operation and was fully recovered by treatment 1 month after operation. The lateral cortical bone of pedicle was cut by 2 screws, but the spinal cord and vertebral artery were fine. The atlas and the fracture of odontoid process of axis were completely replaced in X-ray films of all patients 1 day after operation. The position relation of lag screw and vertebral artery or spinal cord was very good in CT sheets. All cases were followed up with an average of 10.5 months during 9 months to 5 years and 4 months,and obtained atlantoaxial arthrodesis. The breakage of screw and plate was not found in all cases. According to JOA score standard, 16 cases were excellent, 12 were good, 2 were fair, 1 was poor, and the excellent and good rate was 90.32%. CONCLUSION: The personal design and clinical application of X-ray films and CT sheets are of great significance to screw-plate system by pedicle of atlanto-axis because of simplification of designs and methods and better personality.