寰椎椎弓根螺钉和侧块螺钉技术的临床疗效比较

 目的 探讨寰椎椎弓根螺钉和侧块螺钉固定技术的临床疗效。方法 2006年 1月至 2010年 1月, 对 60例寰枢椎失稳患者随机分为两组, 椎弓根螺钉组(32例)均采用寰椎椎弓根螺钉固 定技术, 侧块螺钉组(28例)均采用寰椎侧块螺钉固定技术。通过术中失血量、手术时间、颈枕区疼痛缓 解[采用疼痛视觉模拟评分法(visual analog scale, VAS)评估]、颈椎日本骨科协会评分(Japanese Or thopaedic Association Scores,JOA)和术后植骨融合情况评定疗效。结果 所有患者均获得随访, 随访时 间 12~60个月, 平均 466个月。术后 6个月均获得骨性融合, 未发现螺钉松动、移位, 螺钉断裂, 寰枢椎 再移位及失稳现象。椎弓根螺钉组术前 JOA评分为(7.1±2.8)分, VAS评分(3.0±1.2)分, 末次随访时分 别改善至(13.3±2.1)分和(1.8±0.9)分;侧块螺钉组术前 JOA评分为(7.3±2.4)分, VAS评分(3.2±1.0)分, 末次随访时分别改善至(13.0±2.6)分和(1.9±1.0)分;两组患者在 JOA评分、颈枕区疼痛缓解方面的差异 无统计学意义。 椎弓根螺钉组术中失血量和手术时间明显低于侧块螺钉组, 差异有统计学意义。椎弓根 螺钉组中 2例出现寰椎后弓骨折。侧块螺钉组中有 3例术后出现颈枕区疼痛加重, 且伴有麻木。 结论 寰椎椎弓根螺钉固定技术显露范围小, 简化了操作程序, 减少了术中和术后的并发症。 在设计手术方案时, 应优先考虑椎弓根螺钉技术, 而侧块螺钉技术可以作为一种补充。

Comparative Results Between C1 pedicle screw and C1 lateral mass screw

Objective To compare the clinical outcomes of C1 pedicle screw with C1 lateral mass screw.Methods From Jan 2006 to Jan 2010,60 cases with atlantoaxial instability were randomly divided into two groups:32 cases underwent posterior C1 pedicle screw fixation (the pedicle group) and 28 cases underwent posterior C1 lateral mass screw fixation (the lateral mass group).Patients were followed up at regular intervals.The blood loss,the time of the operation,the JOA Score,VAS Score,and the bone fusion rate were recorded.Results All cases were followed up for an average of 46.6 months (range,12 to 60 months).Bone fusion were achieved 6 month after operations.There were no loose or breakage of screw-rod.Atlantoaxial re-instability was not found in the series.At the last followed up time,the JOA score and VAS score of pedicle group had respectively improved from 7.1±2.8 and 3.0±1.2 preoperatively to 13.3±2.1 and 1.8±0.9 postoperatively; The JOA score and VAS score of lateral mass group had respectively improved from 7.3±2.4 and 3.2±1.0 preoperatively to 13.0±2.6 and 1.9±1.0 postoperatively.There was no difference in JOA Score,VAS Score,and the bone fusion rate between two groups.There were significant difference in blood loss,the time of the operation.Fracture of posterior arch were observed in 2 cases in the pedicle group,and in the lateral mass group,pain and numbness of cervic-occipital region were observed in 3 cases after operation.Conclusion C1 pedicle screw fixation is less invasive and safe technique.Lateral mass screw fixation is a wise option for atlantoaxial instability.