椎弓根钉矫形固定系统在治疗颈椎损伤失稳中的应用

目的:探讨椎弓根钉矫形固定系统在治疗颈椎损伤后失稳的临床应用价值。方法:本组选取颈椎损伤后失稳合并颈椎管狭窄患者7例,难复性颈椎骨折脱位患者11例。合并颈椎管狭窄患者术前X线片测量均有发育性椎管狭窄并椎体间不稳,磁共振显示脊髓受压明显;手术采用颈后路C3~C7单开门减压椎管成形术,不稳节段用自行研制的椎弓根矫形固定系统固定并突间关节间植骨融合。难复性颈椎骨折脱位患者术前均行颅骨牵引后未能复位,术中撬拔复位后用椎弓根钉矫形固定系统固定并植骨融合。结果:术中末出现并发症,术后神经症状明显改善,拍片检查提示置钉位置正确,随诊7~18个月,平均10个月,椎弓根固定系统牢靠,无松动。结论:应用椎弓根钉矫形固定系统一次完成颈椎的复位固定和脊髓减压是一种简捷、可靠的治疗方法,避免了前后路联合手术,近期内疗效满意。

Application of Pedicle Screw Fixation System to the Treatment of Injury and Instability of Cervical Vertebrae

Objective: To explore the value of clinical application of pedicle screw fixation system in the treatment of cervical vertebrae instability after injury.Methods: seven patients with cervical vertebrae instability after injury and 11 patients with irreducible fracture and dislocation of cervical vertebrae were chosen in the group.The preoperative radiographs of the 7 patients with combined spinal canal stenosis were measured and were diagnosed to be developmental spinal canal stenosis and instability of cervical vertebrae.MRI showed the spinal cords were compressed obviously.Posterior C3~7 single open-door decompression and canal-plasty was adopted.Self-designed pedicle screws and inter transverse fusion were used for the unstable segments.Preoperative skull traction was used in the patients with irreducible fracture and dislocation of cervical vertebrae and repositioning was failed.Intraoperative reduction was performed and pedicle screw fixation system and fusion were used.Results: Complications were not found in the operation.The postoperative radiographs showed that the screws were in the right places.The average follow-up observation was 10 months,ranging from 7 to 18 months.After that,The short-term radiographs showed firmly fixed screws.Conclusion: It is a simple and reliable method to reposition and fix the cervical vertebrae and to decompress the spinal cord at one time with pedicle screw fixation system.Anterior and posterior operations were avoided and short-term outcome was satisfied.