颈椎前路钢板在下颈椎损伤的应用进展

对颈椎前路钢板在下颈椎损伤国外应用进展进行综述。颈椎前路钢板在设计上有限制性与非限制性两种类型,生物力学研究表明前者的固定强度明显优于后者,但易于在固定阶段对植骨块产生应力阻挡。手术指征主要为颈椎前柱损伤或颈椎后部骨与韧带复合体的损伤。但颈椎损伤存在高度不稳定时,前路钢板固定应联合颈椎后路稳定性手术。否则,术后须应用头环背心支具固定。对撑开屈曲型损伤,应警惕创伤性颈椎间盘突出,以免在牵引复位过程中发生严重的神经损伤。操作时应彻底解除脊髓前方压迫,植入三面皮质骨块,恢复前柱正常前凸,再行前路钢板固定。该方法的优点是达到了固定阶段即时稳定性,提高了植骨融合率,有利于康复。但加重了手术创伤,有发生与钢板或螺钉有关并发症的可能,晚期在临近融合区相邻椎间盘有退行性改变发生。因而在确定治疗方案时,要权衡利弊。

Progress of anterior cervical plating for lower cervical spine injuries

This article reviews overseas progress of anterior cervical plating for lower cervical spine injuries.Anterior cervical plating has two types plates,constrained and unconstrained plates.Biomechanically study has shown the fixed rigidity of the former significantly superior to the latter,but the constrained plates may stress shield to grate bones at fixed sites.Indications for surgery:the main indications for surgical treatment included lesions of cervical anterior column or cervical posterior osteoligamentous complexs.When cervical lesions was highly instability,anterior cervical plates must combine with posterior cervical stabilization or halo vest cervical orthosis immobilization after operation.The surgeon must be aware of traumatically cervical discs protrusion which may cause severe nerve injury during traction.Sufficient anterior decompression of spinal cord,placement of a tricortical bone graft,reduction of cervical anterior column and fixation of anterior plate lead to a satisfactory clinical results.Advantage of the method includes increasing immediate stabilization of the fused segment,improving fusion rate and benefiting rehabilitation. Shortcoming includes increasing trauma of surgery,complications related to plate or screws,and adjacent fused segment late degeneration of discs.When operation is decided,the factors are considered.