椎弓根螺钉在后路下颈椎重建手术中的应用

目的:探讨应用颈椎椎弓根螺钉后路重建治疗下颈椎疾患的疗效。方法:2001年11月至2003年7月,采用后路椎弓根螺钉内固定治疗下颈椎疾患31例,颈椎椎弓根螺钉进钉点为上位椎体下关节突下端略下方,椎间小关节中央部的略外方(即由侧块的外缘向内约3~5mm),矢状面上内倾30°~45°,钉长为18~26(平均22.3)mm。结果:本组病例置钉193枚,未发生椎动脉和脊髓损伤,术后改善率为84.5%。随访9~28(平均17)月,X线、CT复查示螺钉位置良好,无松动、无断钉,植骨9~12个月左右达到满意的融合。采用日本骨科学会(JOA)评分,由术前平均9.7分提高到术后平均16.3分。结论:颈椎椎弓根螺钉后路重建治疗下颈椎疾患稳定性良好,是可供选择的术式之一。

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OBJECTIVE: To explore the efficiency of the cervical pedicle screws in the posterior reconstructive operation of the lower cervical diseases. METHODS: From November 2001 to July 2003, 31 patients suffering from the lower cervical diseases were treated with the posterior pedicle screws fixation. We put the screws in the inferior articular process of the upper centrum, the lateral of the intervertebral facet center (3 - 5 mm the medial edge of lateral mass). The angles of toe-in sagittal plane varied from 30 degrees to 45 degrees, and the screws were from 18 to 26 mm (22.3 mm) in average. RESULTS: There were 193 pedicle screws in this group, and no one had spinal cord injury or vertebral artery injury. The improvement rate was 84.5%. Follow-up was from 9 to 28 months (17 months in average). The screws were fixed properly without being loose and broken, and the bone graft fusions within 9 to 12 months in the X-ray and CT scan examination were satisfactory. The Japanese orthopaedics association score (JOA) was 9.7 preoperatively, but it was raised to 16.3 postoperatively. CONCLUSION: The posterior reconstructive operation with cervical pedicle screws is a good choice for patients with lower cervical diseases.