组合枢椎椎板螺钉固定技术治疗颈椎损伤的临床研究

目的 探讨组合枢椎椎板螺钉固定技术治疗颈椎损伤的可行性和应用价值.方法 对32具颈椎标本行枢椎椎板轴向CT加密扫描,测量枢椎椎板的长度、高度,枢椎椎板上、中、下部的厚度,椎板轴线与欠状面的夹角.8例颈椎损伤患者中,Anderson Ⅱ型齿状突骨折伴寰枢关节向后脱位2例、向前脱位1例、齿状突骨不愈合1例,Ⅲ型齿状突骨折伴寰枢关节不稳、横韧带撕裂2例,Ⅱ型Hangman骨折伴C<,2～3>不稳1例,寰枢关节前脱位伴横韧带断裂1例.牵引复位后,根据患者病情组合枢椎椎板螺钉进行组合式固定,并行后路自体髂骨植骨融合.结果 枢椎椎板的长度为(26.2±1.2)mm,高度为(12.8±1.6)mm,枢椎椎板上、中、下部的厚度分别为(300±1.4)mm、(6.0±1.6)mm、(5.6±1.2)mm、椎板轴线与矢状面的夹角平均为43.5°.8例患者枢椎椎板螺钉位于椎板中,无偏斜.全部患者随访6～14个月,平均10.5个月.术中和术后没有任何并发症发生,获得了良好的骨性愈合.本组无一例发生螺钉松动及断裂.结论 枢椎椎板螺钉固定技术避免了螺钉置入过程中损伤椎动脉的风险.此技术操作简单,不受C2横突孔中椎动脉的位置限制.全程在直视下进行,该方法可作为传统枢椎后路螺钉固定技术的补充.

Clinical study of combined C2 laminar screw fixation technique for cervical vertebral injury

Objective To explore the feasibility and application value of combined C2 laminar screw fixation technique in treatment of cervical vertebral injury. Methods Dense axial CT scanning was done on C2 laminar of 32 specimens of cervical vertebra to measure the length and height of the axis, the thickness of upper, middle and lower parts of the axis as well as the angle between the axial ray and the sagittal plane. There were eight patients with cervical vertebral injury including two with type Ⅱ odon-told process fractures combined with backward dislocation of atlanto-axial joint, one with forward disloca-tion of atlanto-axial joint, one with nonunion of odontoid process fractures, two with type Ⅲ odontoid process fractures combined with atlanto-axial joint instability and transverse ligament rupture, one with type Ⅱ Hangman fracture combined with instability of C2～3 and one with forward dislocation of atlanto-axial joint combined with transverse ligament rupture. With accomplishment of traction reduction, combined fixation with axis laminar screws and posterior autogenous lilac graft fusion were done based on injury se-verity of the patients. Results The length and height of axis laminar was (26.2±1.2) mm and (12.8±1.6) mm, respectively. The thickness of upper, middle and lower parts of the C2 laminar was (3.0±1.4) mm, (6.0±1.6) mm and (5.6±1.2) mm, respectively. The mean angle between the axial ray and sagittal plane was 43.5°. All patients were followed up for 6-14 months ( mean 6 months), which showed that all patients obtained favourable bone union and all screws remained at sound position, without deflexion of the screws or any perioperative or postoperative complications. No screw loosening or breakage occurred. Conclusions C2 laminar screw fixation technique can prevent the risk of vertebral artery injury during screw insertion. In the meantime, such technique is simple to operate and free from limitation of the vertebral artery in the cervical foramen. Whole course of visualization during C2 laminar screw insertion may facilitate it as a supplementary method for conventional posterior C2 screw fixation.