CAJ | 학술논문

目的探讨应用高速磨钻辅助下颈椎椎弓根钉棒系统治疗下颈椎交锁性脱位的适应证、方法及疗效. 方法回顾性分析2006年12月-2011年7月应用高速磨钻辅助椎弓根钉棒系统复位固定治疗的13例颈椎交锁性脱位患者临床资料.脱位部位:C3/43例,C4/55例,C55/64例,C6/71例.致伤原因:交通伤7例,高处坠落伤6例.2例无任何神经症状,7例合并中央管损伤综合征,4例截瘫.13例患者均在伤后7d内行高速磨钻辅助后路椎弓根螺钉复位内固定术,采用短节段固定,椎弓根钉置入上下相邻的椎弓根内,在复位撑开钳的配合下解除小关节交锁,并复位固定. 结果所有患者均获良好复位,13例患者中8例解剖结构完全复位,5例有1～2 mm轻度滑脱.共置入52枚椎弓根螺钉,术中未出现脊髓、神经根或椎动脉损伤,术后X线片及CT显示除3枚螺钉偏移出椎弓根外,其余49枚螺钉完全位于椎弓根内.随访12-36个月,术后上肢感觉、运动功能明显改善.1例术后3个月断钉,但无神经症状. 结论高速磨钻辅助椎弓根钉棒复位内固定适用于治疗颈椎交锁性脱位,复位过程符合生物力学,同时可行减压治疗.
목적 탐토응용고속마찬보조하경추추궁근정봉계통치료하경추교쇄성탈위적괄응증、방법급료효. 방법 회고성분석2006년12월-2011년7월응용고속마찬보조추궁근정봉계통복위고정치료적13례경추교쇄성탈위환자림상자료.탈위부위:C3/43례,C4/55례,C55/64례,C6/71례.치상원인:교통상7례,고처추락상6례.2례무임하신경증상,7례합병중앙관손상종합정,4례절탄.13례환자균재상후7d내행고속마찬보조후로추궁근라정복위내고정술,채용단절단고정,추궁근정치입상하상린적추궁근내,재복위탱개겸적배합하해제소관절교쇄,병복위고정. 결과 소유환자균획량호복위,13례환자중8예해부결구완전복위,5례유1～2 mm경도활탈.공치입52매추궁근라정,술중미출현척수、신경근혹추동맥손상,술후X선편급CT현시제3매라정편이출추궁근외,기여49매라정완전위우추궁근내.수방12-36개월,술후상지감각、운동공능명현개선.1례술후3개월단정,단무신경증상. 결론 고속마찬보조추궁근정봉복위내고정괄용우치료경추교쇄성탈위,복위과정부합생물역학,동시가행감압치료.
Objective To evaluate the indications,techniques and effects of high speed drill assisted cervical pedicle screw-rod system in treatment of cervical interlocking dislocation.Methods A retrospective review was made on data of 13 cases of cervical interlocking dislocation undergone pedicle screw-rod fixation and reduction with assistance of high speed drills from December 2006 to July 2011.Dislocation localized in C3/4 (n =3),C4/5 (n =5),C5/6 (n =4) and C6/7 (n =1) respectively.Causes for injury contained cervical hyperextension due to traffic accidents (n =7) and a fall from the height (n =6).Two remained neurological intact,seven were combined with syndrome of central canal damage,and four had paraplegia.All the 13 cases received posterior pedicle screw fixation and reduction within 7 days after injury.Pedicle screws were implanted on adjacent segment of cervical spine with unlocking the interlocked small joints by a distraction device.Results All 13 cases obtained good reduction,including eight with complete anatomic reduction and five with 1-2 mm of vertebral slight slippage.Fifty-two screws were inserted and 49 pedicle screws were put in place except for the excursion in three pedicle screws on the postoperative radiographic and CT scans.There was no injury of spinal cord,nerve root or vertebral artery during operation.The patients showed significant improvement in sensory and motor function of the upper extremities in the follow-up of 12-36 months.One case had screw breakage at postoperative three months with no nerve symptoms.Conclusion High speed drill assisted pedicle screw-rod system is suitable for treatment of cervical interlocking dislocation,for its reduction process accords with the biomechanics and allows decompression therapy.