CAJ | 학술논문

目的探讨下颈椎损伤前路椎弓根螺钉固定治疗的初步临床运用. 方法选择2009年1月-2011年12月运用下颈椎前路椎弓根螺钉固定治疗的下颈椎损伤患者22例.所有患者术后均摄X线片及CT以明确螺钉位置、方向、长度,是否有椎弓根皮质穿破、横突孔或椎管的侵犯,同时行MRI检查以明确术后减压情况,是否有硬膜外血肿的形成,颈脊髓变性情况.统计比较患者日本骨科学会( JOA)评分改善情况. 结果术后所有患者均获得随访3～36个月,平均15.5个月.22例共置入下颈椎前路椎弓根螺钉44枚,所有螺钉均顺利置入.所有患者均获得骨性愈合,平均愈合时间4.5个月.所有患者随访中均未发现螺钉松动、脱出、断裂或钢板松动.1例术后出现声音嘶哑,估计与术中长时间牵拉喉返神经有关,予以营养神经等支持治疗,术后复查3周左右患者症状消失.2例术后诉有吞咽不适,告知患者进软食,症状3个月左右明显缓解.术后X线片示下颈椎前路椎弓根螺钉置入位置满意.术后出院前CT横断位像示2枚螺钉在下颈椎椎弓根内侧皮质1度穿破,2枚螺钉外侧缘皮质1度穿破累及横突孔内侧缘.出院前MRI示所有患者脊髓前方压迫均获得明显缓解,4例出现少量硬膜外前方血肿,但无明显脊髓压迫.术后12个月MRI示3例脊髓变性有改善.JOA评分从术前的(8.5±0.7)分提高到术后出院前(14.5±0.8)分(P＜0.01),术后6个月时达(15.7±0.7)分,较出院前又有显著改善. 结论前路椎弓根螺钉固定是一项可靠和安全的下颈椎损伤前路重建技术,临床运用中要注意严格掌握手术适应证.
목적 탐토하경추손상전로추궁근라정고정치료적초보림상운용. 방법 선택2009년1월-2011년12월운용하경추전로추궁근라정고정치료적하경추손상환자22례.소유환자술후균섭X선편급CT이명학라정위치、방향、장도,시부유추궁근피질천파、횡돌공혹추관적침범,동시행MRI검사이명학술후감압정황,시부유경막외혈종적형성,경척수변성정황.통계비교환자일본골과학회( JOA)평분개선정황. 결과 술후소유환자균획득수방3～36개월,평균15.5개월.22례공치입하경추전로추궁근라정44매,소유라정균순리치입.소유환자균획득골성유합,평균유합시간4.5개월.소유환자수방중균미발현라정송동、탈출、단렬혹강판송동.1례술후출현성음시아,고계여술중장시간견랍후반신경유관,여이영양신경등지지치료,술후복사3주좌우환자증상소실.2례술후소유탄인불괄,고지환자진연식,증상3개월좌우명현완해.술후X선편시하경추전로추궁근라정치입위치만의.술후출원전CT횡단위상시2매라정재하경추추궁근내측피질1도천파,2매라정외측연피질1도천파루급횡돌공내측연.출원전MRI시소유환자척수전방압박균획득명현완해,4례출현소량경막외전방혈종,단무명현척수압박.술후12개월MRI시3례척수변성유개선.JOA평분종술전적(8.5±0.7)분제고도술후출원전(14.5±0.8)분(P＜0.01),술후6개월시체(15.7±0.7)분,교출원전우유현저개선. 결론 전로추궁근라정고정시일항가고화안전적하경추손상전로중건기술,림상운용중요주의엄격장악수술괄응증.
Objective To investigate the preliminary clinical application of anterior pedicle screws in treatment of the lower cervical spine injuries. Methods The study involved 22 patients with lower cervical spine injuries treated with anterior pedicle screw technique from January 2009 to December 2011.X-ray and CT images of the patients were taken postoperatively to evaluate whether the position,orientation and length of the screws were appropriate and whether there involved pedicle cortex perforation,transverse foramen or spinal canal invasion.MRI was also performed to ascertain the situation of decompression,the formation of epidural hematoma and the degeneration of cervical spinal cord.The improvement of JOA score was compared statistically. Results All the patients were followed up for 3-36 months ( mean,15.5 months).A total of 44 anterior lower cervical screws were implanted and all screws were inserted smoothly.All the patients had bone healing after average 4.5 months,which showed no loosening,prolapse or breakage of the screws or no loosening of the plate.One patient showed hoarseness postoperatively,which was probably due to the long-term distraction of recurrent laryngeal nerve.The symptom disappeared at around three weeks after neurotrophic support.Two patients complained of dysphagia postoperatively,and were informed of keeping a soft diet.The symptom was remarkably alleviated after three months or so.The X-ray films indicated satisfactory position of the implanted screws.Before discharge,the transaxial CT images showed that two screws perforated the medial pedicle cortex ( 1 ° ) and that two screws perforated the lateral cortex (1 °) and affected the medial margin of the transverse foramen.Before discharge,the MRI indicated obvious alleviation of the anterior spinal cord compression in all patients and a small amount of anterior epidural hematoma in four patients,with no obvious spinal cord compression.At 12 months after operation,the MRI showed significant improvement of spinal cord degeneration in three patients.JOA score was increased from preoperative (8.5 ± 0.7) to ( 14.5 ± 0.8 ) before discharge (P ＜0.01 ).JOA score was (15.7 ±0.7) at six months postoperatively,which was significantly improved as compared with that before discharge. Conclusions Anterior pedicle screw fixation is a reliable and safe method for reconstruction of the anterior lower cervical injuries.Surgical indications should be strictly controlled in its clinical application.