空心钉置入内固定在椎管成形治疗中的应用

背景：恢复脊柱的稳定性已经成为脊柱外科的共识，椎管成形术式不断改进，但如何能让椎管成形获得良好的效果，且价格实惠，许多国内学者开始尝试各种改良术式。目的：评价空心钉置入内固定在椎管成形治疗中的应用价值。方法：2011年2月至2013年2月对24例应用空心钉固定法行椎管成形治疗的脊椎疾病患者进行回顾性分析，其中颈椎管狭窄12例，胸椎肿瘤2例，腰椎肿瘤10例。治疗后对所有患者进行随访并复查CT和MRI，观察治疗后临床症状和影像学改变。颈椎管狭窄患者于治疗前后行JOA评分评估以及椎管横截面积测量；胸腰椎肿瘤患者于治疗前后评估目测类比评分。结果与结论：所有患者均未出现神经、血管损伤等并发症。治疗后随访12-24个月，影像学评估显示内固定确实，未见空心钉脱落移位，沟槽处植骨达骨性愈合，无椎板塌陷或再关门现象。颈椎管狭窄症患者治疗后12个月随访时的JOA评分及椎管横截面积均显著优于治疗前(P < 0.01)。治疗后12个月JOA评分分类评估优良率为92%。治疗后12个月随访，胸腰椎肿瘤患者的目测类比评分由治疗前的(8.2±1.6)分改善到出院后1年的(2.3±1.3)分(P=0.004 2)。提示空心钉在椎管成形治疗中不仅可以增强后柱的稳定性，而且可以提高截骨处的愈合率，价格低廉，操作技术简便，修复效果良好。 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 

Application of the cannulated screws in canaloplasty

BACKGROUND: Restoring the stability of the spine has become the consensus of spinal surgery. The canaloplasty technology has been continuously improved, but how can we get the good clinical effect of the canaloplasty, and the price affordable, many domestic scholars have to try all kinds of the improved operation methods. OBJECTIVE: To evaluate the clinical application value of cannulated screws fixation in canaloplasty. METHODS: From February 2011 to February 2013, totally 24 patients with spinal disease treated by canaloplasty using cannulated screw were retrospectively analyzed, of which 12 cases of cervical stenosis, 2 cases of intraspinal tumor in thoracic and 10 cases of intraspinal tumor in lumbar. All patients were followed up after treatment. Postoperative CT and MRI were done in all patients. Clinical symptoms and radiographic changes were observed after treatment. The Japanese Orthopaedic Association score and the spinal canal cross-sectional area measurement were conducted in the patients with cervical stenosis between the preoperation and postoperation. Visual analog scale score was evaluated in patients who have the tumor in the thoracolumbar spine between the preoperation and postoperation. RESULTS AND CONCLUSION: All patients had no complications such as nerve or blood vessel damage. All patients were followed up 12 to 24 months. Imaging evaluation showed that internal fixator was stable without the hollow screw loss or displacement. The bone grafting in groove reached bone fusion. There was no occurrence of lamina collapse or “re-close of door”. The Japanese Orthopaedic Association score and spinal canal cross-sectional area of patients with cervical stenosis during the follow-up after 12 months of treatment were significantly superior to those in preoperation (P < 0.01). After 12 months of treatment, Japanese Orthopaedic Association scores showed that the excellent rate of classification assessment was 92%. During the follow-up after 12 months of treatment, the visual analog scale of patients with thoracolumbar tumor improved from (8.2±1.6) points before treatment to (2.3±1.3) points at the first year after discharge (P=0.004 2). These results suggest that the application of cannulated screws in the canaloplasty can not only enhance the stability of the rear pillar, and can improve the healing rate of osteotomy, and has the characteristics of inexpensive, easy to operate, and repair effect is good.