CAJ | 학술논문

目的探讨经后路寰枢椎椎弓根钉棒系统内固定融合术治疗上颈椎损伤的可行性、方法、疗效和适应证. 方法对13例上颈椎损伤患者行后路寰枢椎椎弓根钉棒系统内固定融合术.其中陈旧性齿状突骨折不愈合4例,新鲜齿状突骨折(Aderson Ⅱ C型)2例,寰椎横韧带断裂3例,寰椎骨折4例.13例均采用美国强生Depuy公司生产的后路Summit钉棒系统和山东威高公司生产的PCF钉棒系统行后路寰枢椎椎弓根内同定(万向螺钉直径3.5 mm,寰椎螺钉长26～30 mm,平均28 mm,枢椎螺钉长24～28 mm,平均26 mm),术后不用外固定或用颈领保护1～3个月. 结果 13例共置入寰椎椎弓根螺钉26枚,枢椎椎弓根螺钉26枚.平均手术时间2.6 h,平均出血量470 ml.术中未发生椎动脉和脊髓损伤.全组患者获得4～25个月(平均13个月)随访.临床症状得到不同程度的改善,有神经损伤患者日本骨科协会(JOA)评分改善率为72%～91%,平均81%.X线、CT复查示螺钉位置良好,无钉棒断裂、变形、松动,1枚寰椎螺钉前端穿透侧块内上皮质约3 mm,但未影响寰枕关节活动,其余位置满意.3～6个月后所有患者均获植骨融合.1例寰椎骨折患者出现寰枕腹侧融合. 结论经后路寰枢椎椎弓根钉棒系统内固定融合术治疗上颈椎损伤具有可行性,如果操作方法得当,疗效较好,适应证较广,应用前景广阔.
목적 탐토경후로환추추추궁근정봉계통내고정융합술치료상경추손상적가행성、방법、료효화괄응증. 방법 대13례상경추손상환자행후로환추추추궁근정봉계통내고정융합술.기중진구성치상돌골절불유합4례,신선치상돌골절(Aderson Ⅱ C형)2례,환추횡인대단렬3례,환추골절4례.13례균채용미국강생Depuy공사생산적후로Summit정봉계통화산동위고공사생산적PCF정봉계통행후로환추추추궁근내동정(만향라정직경3.5 mm,환추라정장26～30 mm,평균28 mm,추추라정장24～28 mm,평균26 mm),술후불용외고정혹용경령보호1～3개월. 결과 13례공치입환추추궁근라정26매,추추추궁근라정26매.평균수술시간2.6 h,평균출혈량470 ml.술중미발생추동맥화척수손상.전조환자획득4～25개월(평균13개월)수방.림상증상득도불동정도적개선,유신경손상환자일본골과협회(JOA)평분개선솔위72%～91%,평균81%.X선、CT복사시라정위치량호,무정봉단렬、변형、송동,1매환추라정전단천투측괴내상피질약3 mm,단미영향환침관절활동,기여위치만의.3～6개월후소유환자균획식골융합.1례환추골절환자출현환침복측융합. 결론 경후로환추추추궁근정봉계통내고정융합술치료상경추손상구유가행성,여과조작방법득당,료효교호,괄응증교엄,응용전경엄활.
Objective To investigate the methods, feasibility, outcome and indications of atlantoaxial pedicle screw system in the treatment of upper cervical injury. Methods Thirteen patients with upper cervical injury were treated by atlantoaxial pedicle screw system. There were four patients with old odontoid fractures, two with new odontoid fractures (Aderson ⅡC), three with rapture of the transverse ligament of C1 and four with C1 fracture. Results A total of 26 pedicle screws and 26 pedicle screws were implanted. The mean operation time and perioperative blood loss were 2.6 hours and 470 ml, respectively. No injury to the vertebral artery and spinal cord was observed. All patients were followed up for 4-25 months (mean 13 months). The clinical symptoms were improved to some extent according to Japanese Orthopedic Association scoring system, with improvement rate of 72%-91% (mean 81%). The screws were verified to be fixed in a proper position, and no hardware broken or loosening was observed except for one C1 screw penetrating the medial superior cortex of lateral mass for 3 mm without affecting occipito-aflantal motions. All patients had a solid bony fusion 3-6 months later. Conclusion The atlantoaxial pedicle screw system is feasible in the treatment of upper cervical injury with the advantages of better outcomes and wider indications.