寰椎椎弓根螺钉置入的解剖学及临床效果分析

Anatomical and clinical effect of atlas pedicle screw implantation

摘要:

目的 研究寰椎椎弓根螺钉置入的解剖学及临床效果。方法 选取46 例由承德医学院解剖教研室 提供的健康完整的寰椎标本予以解剖学测量，明确寰椎椎弓根螺钉进钉点与置钉的角度。选取2013 年3 月— 2015 年3 月于承德医学院附属医院接受后路寰枢椎切开复位内固定术治疗的寰枢椎不稳患者30 例为对照组， 置钉方式为传统置钉。另取2015 年8 月—2017 年8 月同院接受后路寰枢椎切开复位内固定术治疗的寰枢椎 不稳患者33 例为实验组，以局部解剖标志为参考的寰椎徒手椎弓根置钉方式置钉。比较两组各项手术指标， 手术前后Oswestry 功能障碍指数问卷表（ODI）及日本骨科协会评估治疗分数（JOA 评分），术后并发症发 生情况。结果 实验组手术时间、术中失血量、置钉时间均低于对照组，差异有统计学意义（P <0.05）。手术 前后两组患者ODI 及JOA 评分比较差异无统计学意义（P >0.05）；而术后两组患者ODI 评分均低于术前， JOA 评分均高于术前，差异有统计学意义（P <0.05）。结论 以局部解剖标志为参考的寰椎徒手椎弓根置钉方 式置钉效果更佳，有利于改善患者的脊柱功能以及颈椎功能。

Abstract:

Objective To study anatomical and clinical effect of atlas pedicle screw implantation. Methods A total of 46 atlas sample were measured by crew from Department of Anatomy, Chengde Medical College for information of entry point and angle of pedicle screws. Totally 30 cases of control group who were admitted into our hospital from March 2013 to March 2015 underwent posterior atlantoaxial internal fixation by conventional pedicle screw way for treatment of atlantoaxial instability. Another 33 cases in experimental group who were admitted into our hospital during August 2015 to August 2017 underwent posterior atlantoaxial internal fixation with local anatomical landmarks for treatment of atlantoaxial instability. The operation indexes, ODI and JOA score before and after surgery, and postoperative complications were recorded in two groups. Results operation time, intraoperative blood loss and insertion time in experimental group were decreased significantly when compared with those in control group (P < 0.05). No obvious differences in ODI and JOA scores pre- and post-surgery were identified between groups (P > 0.05). ODI was decreased while JOA was increased post-surgery greatly in both groups when compared with that prior to surgery (P < 0.05). Conclusion Local anatomical landmarks is a promising pre-surgery evaluating system for atlas screw placement.