颈椎椎弓根个体化固定技术治疗261例颈椎疾患临床观察

目的:探讨颈椎椎弓根内固定技术在颈椎疾患的个体化方案设计及临床疗效。方法:对261例颈椎疾患,置入1102枚椎弓根螺钉,其中上颈椎疾患83例,下颈椎疾患178例。应用图像存储传输系统(picture archiving and communication system,PACS),采用X线片及64排CT片,对2 000例正常人颈椎椎弓根的冠状位、矢状位、横断位进行精确测量,得出中国人椎弓根的长度、宽度、高度、向内侧倾斜、向头、尾侧倾斜角度的数据值。术前对每位患者拟固定颈椎的椎弓根精确测量,术中应用自制的颈椎椎弓根定位导向器,准确定位入钉点及角度。结果:一次成功1 086枚,16枚经调整后成功,一次成功率98.55%。术后235例患者获12～73个月随访,平均随访时间18.74个月。采用JOA评分标准[1],优131例,良82例,可17例,差5例,优良率88.1%。所有患者X线片示寰椎完全复位,枢椎齿状突骨折处对位良好,均获得骨性融合,未发现钉板断裂。CT片示螺钉与椎动脉及脊髓位置关系良好。下颈椎患者中,15例患者16枚椎弓根螺钉术后拍片位置不理想,行二次手术调整,无脊髓及椎动脉损伤。119例骨折脱位的患者中117例完全复位,融合率为98.3%。结论:应用椎弓根技术治疗颈椎疾患可以获得即刻三维稳定,融合率高,是一种可行值得推广的方法。

Clinical observation of 261 cases of cervical diseases treated by cervical pedicle screw internal fixation

Objective：To discuss the individual application of cervical pedicle screw internal fixation in cervical disease and its effectiveness. Methods： A total of 1 102 pedicle screws were fixed in 261 patients with cervical diseases, of which 83 had upper cervical problems and 178 had lower problems. Pedicles lengths of the involved cervical vertebra were measured accurately with picture arching and communication which were performed on 235 cases for 12-73 months with an average of 18.74 months, excellent outcomes were presented in 131 cases, good in 82 cases, normal in 17 cases and poor in 5 cases according to the JOA criterion. The rate of excellent and good outcome was 88.1%. X-ray showed displaced atlases or odontoid fractions of epistropheus were all successfully fixed with bone fusion. No broken screws were found. CT scan showed spatial location of arteriae vertebralis, spinal cord and screws was suitable. 16 screw in 15 ca- ses needed a second operation due to improper position of screws. Conclusion= Immediate three-dimensional stability and high fusion rate can be achieved with cervical pedicle screw internal fixation in cervical disease; this technique is a viable approach worthy application in large scale.