《中国康复理论与实践》 ›› 2008, Vol. 14 ›› Issue (08): 719-721.

• 专题 • 上一篇    下一篇

全椎板切除并全颈椎弓根钉棒系统重建治疗急性多节段脊髓损伤

杜世新; 贾艳丽; 罗绍伟; 邱开封; 胡军; 刘东昕; 夏雪; 王虎   

  1. 汕头大学医学院第一附属医院骨科,广东汕头市 515041
  • 收稿日期:2008-04-29 出版日期:2008-08-01 发布日期:2008-08-01

Reconstruction of Spinal Alignment with Total Laminonectomy and Cervical Transpedicular Screws Techniques Applied in Acute Multi-segments Spinal Cord Injury

DU Shi-xin, JIA Yan-li, LUO Shao-wei, et al   

  1. The Department of Orthopaedic, the First Clinical College of Shantou University, Shantou 515041, Guangdong, China
  • Received:2008-04-29 Published:2008-08-01 Online:2008-08-01

摘要: 目的探讨经颈椎后路行全椎板切除减压、颈椎弓根螺钉三维钉棒系统重建治疗伴或不伴颈椎后凸畸形的多节段急性脊髓损伤的疗效。方法对27例伴或不伴颈椎后凸畸形的多节段急性脊髓损伤的患者,行后路颈椎全椎板切除减压、小关节植骨融合、颈椎弓根钉棒系统内固定重建。根据术前、术后3个月随访时颈椎的标准侧位X光片、颈椎CT,以ASIA评分评估脊髓功能改善情况。术后随访3~24个月,平均10个月。结果所有病例均获骨性融合。术后3个月ASIA评分与术前比较均有提高。由于解剖的因素,应用颈椎弓根螺钉重建在术中较易损伤椎动脉。结论一期行颈椎后路椎板切除减压、椎弓根钉棒系统内固定重建颈椎序列是治疗伴或不伴颈椎后凸畸形的多节段急性脊髓损伤的有效方法。

关键词: 脊髓, 颈椎, 椎弓根螺钉, 椎板切除

Abstract: Objective To assess the efficiency of total laminectomy and transpedicular screw placement techniques and a thoroughly decompression with a three column fixation device on the early cervical spine cord injury.Methods 27 patients were operated successfully with total cervical laminectomy through transpedicular screw techniques.Precise measurements of all cervical spines were made by postoperative CT scan of pedicle dimensions,angulation,and offset relative to the lateral mass boundaries.And meanwhile,cortical integrity and neurovascular injury were then assessed by obtaining postoperative computed tomography scans of each patient.Results Using manual techniques,220 pedicles were instrumented and all the cases were followed up between three to twenty-four months.The postoperative gradations were obviously better than the preoperative evaluation.Regardless of the technique used,the vertebral artery was the structure most likely to be injured.Conclusion Insufficient correlation between different surgeons' assessments of surface landmarks attests to the inadequacy of screw insertion techniques in the cervical spine based on such specific topographic.At the early stage of cervical spinal cord injury,using total laminonectomy decompression through cervical screws techniques to reconstruct spinal alignment could improve the prognosis of patients.

Key words: spinal cord, cervical vertebrae, transpedicular screw, laminectomy