改良枢椎椎板螺钉置钉方法的临床应用

目的设计一种改良的枢椎椎板螺钉置钉方法并应用于临床,使螺钉置入更简单、更准确。方法改良枢椎椎板螺钉置钉方法的进钉点仍为棘突和椎板的交界处,但在椎板中份用磨钻磨除少许皮质开窗,用刮匙刮除松质骨,保留椎板内板,用手钻沿着枢椎椎板钻孔,在直视下通过开窗处,再继续向前钻入,探针探查钉道并攻丝后置入直径3.5~4.0 mm、长度24~30 mm螺钉。临床应用26例,其中男17例,女9例,平均年龄56.7岁。结果共置入42枚枢椎椎板螺钉,螺钉平均长度为27.1 mm(24~30 mm),术中无需透视,术中和术后无明显技术相关的并发症发生。术后即刻或随访CT示椎板螺钉位置正确,均位于椎板间。全组病例平均随访13.4个月,未发生螺钉松动、脱出或断裂。结论改良的枢椎椎板螺钉置入技术操作简单,无需透视,并保证了螺钉处于正确位置。

Modification of Wright's technique for axial translaminar screw fixation

Objective To describe and illustrate a modification of Wright''s technique for axial translaminar screw fixation. Methods With our modified technique,a small unicortical "hole" was made at the middle of the contralateral lamina,and the screw could be directly visualized through the unicortical "hole" to prevent violating the spinal canal. Twenty-six patients (17 males and 9 females,average age 56.7 years) underwent insertion of unilateral or bilateral translaminar screws by using our modified technique. Results With this modified technique,42 axial translaminar screws were inserted successfully without fluoroscopy. The mean length of the axial laminar screws was 27.1(range 24-30) mm. There were no intraoperative surgeryrelated complications. The mean follow-up period was 13.4 months. During the follow-up,no pullout,loosening,or breakage of the screws was observed. Conclusion The modified technique provides axial translaminar screw fixation procedure which is simple to operate,without the need of fluoroscopy,and accurate placement of screws.