【摘要】 目的讨论颈椎侧块钢板内固定术在颈椎骨折脱位治疗中的应用。方法1998年1月～2001年1月,在颈后路减压术中采用颈椎侧块钢板内固定加植骨术治疗下颈椎骨折脱位21例。后正中切口,显露至两侧关节突外缘,根据骨折脱位情况进行术中减压、复位、选择颈椎侧块钢板,采用Magerl方法(即螺钉的进入点位于侧块中心内上侧2mm,钉的走行方向约向外倾斜20°～25°,向头侧倾斜30°～40°),选取合适螺钉进行固定,螺钉应穿透远侧骨皮质。结果随访9个月～3年9个月,平均27个月。术后摄X线片,颈椎完全复位20例,复位不完全1例。术后颈围保护下坐起时间平均为术后第4d(2～7d),无脊髓损伤或C级以下脊髓损伤病例离床活动时间平均为术后第9d(3～14d)。术后6个月21例患者均获得良好骨性融合。18例脊髓损伤患者按ASIA分级平均提高1级,2例神经根损伤术后神经功能完全恢复。未发生椎动脉或神经根损伤、脊髓损伤或脊髓损伤加重等严重并发症。结论颈椎侧块钢板内固定术适应范围广,具有固定坚强、节段短、利于复位等特点,为颈后路内固定提供了一种有效、可靠的新方法。更多还原

【Abstract】 Objective To discuss the application of cervical lateral mass plate for the treatment of fractures and dislocations of the cervical spine. Methods From January 1998 to January 2001, internal fixation with cervical lateral mass plate and bony fusion were performed in 21 patients during posterior decompression for the treatment of fractures and dislocations of the lower cervical spine . A posterior median approach was used to expose the lateral edge of the articular process. All patients received spinal decompression and reduction according to the types of fracture and dislocation. A cervical lateral mass plate was applied in each lateral mass, a suitable bicortical screw was inserted using Magerl technique (the inserting point of the screw was 2 mm medial and superior to the center of lateral mass, the direction was 20°-25° laterally and 30°-40° cranially). Results The follow-up of all 21 cases ranged from 9 months to 3 years and 9 months (with the mean of 27 months). There were 20 cases with complete reduction of antero-posterior and rotational dislocation, and 1 case with incomplete reduction according to post-operative X-ray film. Patients could sit up with the protection by wearing soft collar 4 days (2-7 days) after the surgery. The mean off-bed time of those without spinal cord injuries or with spinal cord injuries less than Frankel C grade were 9 days (3-14 days) after operation. All cases obtained solid bony fusion 6 months postoperatively. Eighteen cases with spinal cord injury improved one ASIA grade, 2 cases without root injury obtained complete recovery eventually. No severe complications such as injuries of vertebral artery, nerve root and spinal cord or aggravation of spinal cord injury occurred. Conclusion Cervical lateral mass plate fixation has the advantages of wide indications, strong stability, short segment fixation and easily reduction. The results suggested that this technique is an efficient, reliable segmental posterior fixation.更多还原