摘要
目的探讨对颈椎伤病行颈椎椎弓根螺钉系统(cervicalpediclescrewsystem,CPSS)内固定的临床应用价值。方法回顾性分析52例颈椎伤病患者行CPSS内固定的应用情况。每位患者术前均行X线、CT等影像学检查,术中在“C”型臂X线机侧位或斜位监视下置钉,术后均摄X线片观察螺钉位置。38例平均随访13个月,观察内固定及神经症状恢复情况。介绍置钉方法,总结CPSS的应用价值,分析可能发生的并发症,探讨适应证。结果52例螺钉均成功置入,术中无脊髓、椎动脉损伤,其中9例(10侧)经椎弓根置钉时出现神经根刺激症状,调整置钉方向后置入成功。术后X线片提示螺钉位置良好。随访时未发现断钉、脱钉现象。临床应用证实CPSS内固定有椎间撑开作用,并对向椎管内移位的骨折块及创伤性椎间盘突出有间接复位作用。结论CPSS内固定是可供选择的颈椎后路固定方法之一,但应严格掌握适应证,术中须谨慎操作。
Objective To apply cervical pedicle screw system (CPSS) to treat cervical disorders and discuss its surgical indications, techniques and clinical effectiveness. Methods A total of 52 patients with middle and lower cervical spine lesions who underwent cervical transpedicular fixation were analyzed retrospectively. There were 41 males and 11 females aging from 16 to 62 years. The diagnosis of the patients were fractures and dislocations of cervical spine accompanied by complete paralysis (28 cases) or incomplete paralysis (19 cases) in 47 cases, and metastatic bone tumor in 5 cases. Prior to surgery, anteroposterior and lateral radiographs, CT scan through bone windows, and/or magnetic resonance images were carried out in all patients. During surgery, all screws were inserted into the pedicle under the guidance of lateral or oblique image intensifier to confirm the direction and insertion depth of screws. In 7 to 14 days after surgery, physical examination and roentgenograms evaluations were performed in all patients, and CT scans were obtained in 31 patients, the location of screws were evaluated with the radiographic examinations and CT scan. The follow-up period averaged 13 months (range, 1 to 36 months) in 38 patients. The authors experiences in achieving accurate pedicle screw insertion was introduced, the clinical value of using cervical pedicle screw system to manage cervical lesions was summarized, the possible complications of CPSS were analyzed, the candidates of using CPSS were discussed as well. Results Pedicle screws were inserted successfully in all cases, 9 cases were found to have nerve irritating symptoms by 10 pedicle screws when which were introduced into pedicles, however, by changing the direction of the screws, all symptoms disappeared and screws were successfully inserted. Postoperative radiographic evaluation confirmed proper insertion of screws except 2 screws perforating the lateral pedicle wall but without injury of the vertebral artery demonstrated on CT scans. In the followed-up, no screw breakage and loosening was observed. By applying distractive force between the screws placed into pedicles, the space between the affected vertebrae and discs could be increased, displaced anterior fragments of bone or disc could also be indirectly reduced from the spinal canal, and additional anterior decompression interventions might be avoided. Conclusion CPSS can be considered as one of alternative in posterior cervical internal fixation systems. However, specific caution must be taken. The candidates of utilizing CPSS should be properly selected.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第10期590-594,共5页
Chinese Journal of Orthopaedics
