中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
13期
890-893
,共4页
钱列%李立钧%潘杰%周炜%刘养洲%曾诚%李昕%滕红林%庞清江%谭军
錢列%李立鈞%潘傑%週煒%劉養洲%曾誠%李昕%滕紅林%龐清江%譚軍
전렬%리립균%반걸%주위%류양주%증성%리흔%등홍림%방청강%담군
颈椎病%寰椎%内固定器
頸椎病%寰椎%內固定器
경추병%환추%내고정기
Cervical spondylosis%Atlas%Internal fixators
目的 针对上颈椎后路手术中C_(1-2)间静脉窦的解剖特点,寻求更安全的C_1后路螺钉内固定方法.方法 回顾分析了2001至2008年48例(96侧)上颈椎后路内固定手术病例,其中C_1、C_2新鲜骨折28例,先天畸形、陈旧性骨折脱位20例.其中Gcel侧块螺钉12例(24侧)、谭明生椎弓根螺钉法14例(28侧)、经C_1后弓下缘结合骨腊柱保护C_(1-2)间静脉窦法22例(44侧).结果 经C_1后弓下缘结合骨腊柱保护C_(1-2)间静脉窦法病例共22例(44侧)中出血O例,未采用骨腊柱保护者26例(52侧),出血例侧为5例,其中,行Gcel法侧块螺钉植入固定3例(12.5%),与经C_1后弓下缘法相比出血发生率高(P<0.05),谭明生法经后弓寰椎螺钉2例(7.1%),与经C_1后弓下缘法出血发生率差异无统计学意义(P>0.05),Goel法侧块螺钉植入固定组与谭明生法组出血发生率差异无统计学意义(P>0.05).术中置钉96枚均获得成功,48例患者术后3～6个月时均获随访,未发现螺钉松动、断钉等现象.结论 经C_1后弓下缘结合骨腊柱保护法,有良好的骨性标志、良好的血管保护、较大的骨性把持以及广泛的适用性,可减少静脉窦损害、增加手术安全性.
目的 針對上頸椎後路手術中C_(1-2)間靜脈竇的解剖特點,尋求更安全的C_1後路螺釘內固定方法.方法 迴顧分析瞭2001至2008年48例(96側)上頸椎後路內固定手術病例,其中C_1、C_2新鮮骨摺28例,先天畸形、陳舊性骨摺脫位20例.其中Gcel側塊螺釘12例(24側)、譚明生椎弓根螺釘法14例(28側)、經C_1後弓下緣結閤骨臘柱保護C_(1-2)間靜脈竇法22例(44側).結果 經C_1後弓下緣結閤骨臘柱保護C_(1-2)間靜脈竇法病例共22例(44側)中齣血O例,未採用骨臘柱保護者26例(52側),齣血例側為5例,其中,行Gcel法側塊螺釘植入固定3例(12.5%),與經C_1後弓下緣法相比齣血髮生率高(P<0.05),譚明生法經後弓寰椎螺釘2例(7.1%),與經C_1後弓下緣法齣血髮生率差異無統計學意義(P>0.05),Goel法側塊螺釘植入固定組與譚明生法組齣血髮生率差異無統計學意義(P>0.05).術中置釘96枚均穫得成功,48例患者術後3～6箇月時均穫隨訪,未髮現螺釘鬆動、斷釘等現象.結論 經C_1後弓下緣結閤骨臘柱保護法,有良好的骨性標誌、良好的血管保護、較大的骨性把持以及廣汎的適用性,可減少靜脈竇損害、增加手術安全性.
목적 침대상경추후로수술중C_(1-2)간정맥두적해부특점,심구경안전적C_1후로라정내고정방법.방법 회고분석료2001지2008년48례(96측)상경추후로내고정수술병례,기중C_1、C_2신선골절28례,선천기형、진구성골절탈위20례.기중Gcel측괴라정12례(24측)、담명생추궁근라정법14례(28측)、경C_1후궁하연결합골석주보호C_(1-2)간정맥두법22례(44측).결과 경C_1후궁하연결합골석주보호C_(1-2)간정맥두법병례공22례(44측)중출혈O례,미채용골석주보호자26례(52측),출혈례측위5례,기중,행Gcel법측괴라정식입고정3례(12.5%),여경C_1후궁하연법상비출혈발생솔고(P<0.05),담명생법경후궁환추라정2례(7.1%),여경C_1후궁하연법출혈발생솔차이무통계학의의(P>0.05),Goel법측괴라정식입고정조여담명생법조출혈발생솔차이무통계학의의(P>0.05).술중치정96매균획득성공,48례환자술후3～6개월시균획수방,미발현라정송동、단정등현상.결론 경C_1후궁하연결합골석주보호법,유량호적골성표지、량호적혈관보호、교대적골성파지이급엄범적괄용성,가감소정맥두손해、증가수술안전성.
Objective To introduce a new C, screw insertion technique to avoid injury to C_(1-2) venous sinus in posterior atiantoaxial fixation. Methods 48 cases (96 sides of C_1 screws) undergoing posterior atiantoaxial fixation were retrospectively analyzed, including 28 cases of C_1 or C_2 fresh fracture and 20 cases of congenital malformation or old fracture &dislocation, among which 12 cases (24 sides) were operated by Coel lateral mass screws, 14 cases (28 sides) by TAN Mingsheng C_1 transpedicular screws and 44 sides of C, screws in 22 cases were inserted via notch on underside of C, posterior arch combined with bone wax column protecting C_(1-2) venous sinus. Results Bleeding was encountered in five sides of C_1 screws among 26 cases (52 sides) whose venous sinuses were not protected by bone wax column, involving 3 cases of Coel lateral screw implant fixation. There was statistical difference in the incidence rate of bleeding between Coel technique and ours ( P < 0.05) while there was no statistical difference between C_1 transpedicular technique and ours (P>0. 05) or between Goel sides of Goel lateral mass screws (12. 5% ) and 2 sides of C_1 transpedicular screws (7. 1% ). It occurred in none of 22 cases (44 sides) with our presented technique. There was a significant difference between Goel lateral screw implant fixation and C_1 transpedicular technique (P > 0. 05 ). All the screws were implanted successfully. All cases were followed up and there was not any sign of implant failure. Conclusions Our presented C_1 screw insertion technique can provide a better bony landmark and vascular protection, stronger bony holding power and more extensive applicability to reduce injury to C_(1-2) venous sinus and increase the surgical safety.
