下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

Objective To discuss the effect of transarticular screws combined with lateral mass screws or pedicle screws through posterior approach in the lower cervical spine. Methods From February 2003 to October 2007, 22 patients were treated using transarticular screws internal fixation combined with lateral mass screws or pedicle screws in Axis plating system and Vertex system. There were cervical fracture and dislocation in 13 patients, ossification of the posterior longitudinal ligament in 4, cervical canal stenosis associated with dentoid process fracture in 1, and cervical disc herniation associated with cervical stenosis in 4 patients. Lamina or facet bone grafting were used to achieve a long-term stability, with decompression and anterior approach or not. The starting point for screw insertion was located 1 mm medial to the midpoint of the lateral mass and the direction of the screw was 40° caudally in the sagittal plane and 20° laterally in the axial plane. Results All screws insertion was successful. A total of 45 transarticular screws were inserted, with 2 in C4,5, 39 in C5,6 and 4 in C6,7. A total of 12 lateral mass screws were inserted, with 6 in C3 and 6 in C4. A total of 41 pedicle screws were inserted, with 4 in C2, 2 in C3 and 6 in C4, 21 in C7 and 8 in T1. There was no complication related to screw insertion, such as injury to the vertebral artery, nerve roots or spine cord. The follow-up period ranged from 10 months to 3 years and 8 months (mean 17 months). All cases got bone fusion. Only one instance of screw partial backout was identified, but fusion was achieved in all pa-tients. In the follow-up period, only one instance of screw partial backout was identified, but fusion was achieved in all patients. Conclusion The combined use of transarticular screws and lateral mass screws or pedicle screws fixation in the lower cervical spine can enlarge the advantages of strong stability,relatively simple, and reduce operating risk when performed appropriately.     

颈椎经关节椎弓根螺钉固定与标准椎弓根螺钉固定的生物力学比较

Objective To compare biomechanical pullout strength of cervical transfacet pedicle screws to that of standard pedicle screws. Methods Ten fresh human cadaveric cervical spines were harvested. On one side, transfacet pedicle screws were placed at the C3,4, C5,6, and C7T1 levels. On the other side, pedicle screws were, placed at the C3, C5, and C7 levels. The screw insertion technique at each level was randomized for right or left. The starting point for the transfacet pedicle screw insertion was about located at the midpoint of the inferolateral quadrant of the lateral mass and the direction of the screw was about 50° caudally in the sagittal plane and about 45° medially in the axial plane. Screws were placed across the facet joint and the pedicle into the body of the caudal vertebra. The entry points for pedicle screw was located at the midpoint of the superolateral quadrant of the lateral mass and the direction of the screw was about 45° toward the midline in the transverse plane and toward the upper third of the vertebral body in the sagittal plane. The pedicle screws were oriented along the axis of the pedicle in an effort to avoid violations of the cortical wall. All the screw insertions were based on direct observation and the CT scan on the pedicles. After screw placement, axial pullout testing was performed. Results The mean pullout strength for the transfacet pedicle screws was (694±42) N. This compares with (670±36) N for the pedicle screws (P< 0.05). The greatest difference at a single level in pullout strength was observed at the C5,6 level, with a mean difference of 38 N. Conclusion Transfacet pedicle screws exhibited statistically greater pullout strength to pedicle screws. At each level the transfacet pedicle screws exhibited greater pullout strength than the pedicle screws. Posterior transarticular pedicle screw fixation in the cervical spine affords an alternative to standard screw placement for plate fixation and cervical stabilization.     

颈椎椎间孔螺钉、侧块螺钉及椎弓根螺钉的生物力学强度比较

目的比较椎间孔螺钉(paravertebral foramen screws,PVFS)、侧块螺钉(lateral mass screws,LMS)与椎弓根螺钉(pedicle screws,PS)的生物力学强度。方法选取8具新鲜冰冻尸体,男4具、女4具,死亡时年龄(45.3±11.2)岁。CT检查排除骨折、畸形、感染、肿瘤等疾病引起的骨质破坏或其他异常,最终筛选出30个C3~C6颈椎脊椎。将制备完成的颈椎节段标本顺序编号,应用随机数字表法将其随机分为三组,每组10个标本,分别用于双侧置入椎间孔螺钉(4.5 mm×12 mm螺钉)、侧块螺钉(3.5 mm×14 mm)与椎弓根螺钉(3.5 mm×24 mm螺钉)。随机选取一侧进行直接拔出力测试(速度5 mm/min),另一侧进行疲劳测试(位移±1.0 mm,频率1 Hz,循环500次)及残余拔出力测试。结果椎间孔螺钉的直接拔出力为(327.10±17.07)N,侧块螺钉为(305.71±11.63)N,椎弓根螺钉为(635.67±22.82)N。椎间孔螺钉的残余拔出力为(265.62±18.19)N,侧块螺钉为(192.80±17.10)N,椎弓根螺钉为(494.89±41.79)N。椎间孔螺钉、侧块螺钉和椎弓根螺钉的残余拔出力较直接拔出力均有不同程度降低(tPVFS=7.795,tLMS=17.267,tPS=9.349,P<0.001),分别下降了18.8%、36.93%和22.15%。椎弓根螺钉的直接拔出力高于椎间孔螺钉和侧块螺钉(t=34.245,t=40.741,P<0.001),椎间孔螺钉略高于侧块螺钉(t=3.275,P=0.004)。残余拔出力椎弓根螺钉最高,椎间孔螺钉次之,侧块螺钉最小(F=314.619,P<0.001)。椎间孔螺钉的首次循环载荷和首次达到设定位置时载荷均高于侧块螺钉(t=3.625,P=0.002;t=5.388,P<0.001)和椎弓根螺钉(t=2.575,P=0.019;t=2.680,P=0.015),侧块螺钉与椎弓根螺钉的差异无统计学意义(t=0.609,P=0.550;t=1.953,P=0.067)。椎间孔螺钉与椎弓根螺钉的末次循环载荷均高于侧块螺钉(t=5.341,P<0.001;t=3.439,P=0.003),但椎间孔螺钉与椎弓根螺钉的差异无统计学意义(t=1.606,P=0.126)。结论椎间孔螺钉的直接拔出力略高于侧块螺钉,残余拔出力明显高于侧块螺钉,抗疲劳性能与椎弓根螺钉相近并明显优于侧块螺钉,因此,颈椎椎间孔螺钉具有作为侧块螺钉和椎弓根螺钉有效替代的潜能。     

下颈椎经关节螺钉联合侧块或椎弓根螺钉固定的效果

目的 探讨在下颈椎经颈后正中入路应用经关节螺钉联合侧块螺钉或椎弓根螺钉行内固定治疗的固定效果.方法 2003年2月至2007年10月,对22例患者通过后路应用经关节螺钉联合侧块螺钉或椎弓根螺钉行内固定治疗,男14例,女8例;年龄24～73岁,平均43岁.其中下颈椎创伤性骨折脱位13例,颈椎后纵韧带骨化症4例,颈椎管狭窄伴Ⅱ型齿突骨折1例,颈椎间盘突出伴椎管狭窄4例.结果 共置入经关节螺钉45枚,其中C4,5 2枚,C5,639枚,C6,74枚;共置入侧块螺钉12枚,C3、C4各6枚;共置入椎弓根螺钉41枚,其中C24枚,C32枚,C46枚,C721枚,T18枚.术中所有螺钉均成功置入,未出现椎动脉、神经根和脊髓损伤等置钉相关并发症.22例患者均获随访,随访时间10个月～3年8个月,平均17个月.植骨融合时间3～5个月,平均3.5个月.术后发现1例患者的2枚经关节螺钉松动,部分脱出.经加强颈托制动,术后4个月获得融合.结论 通过后路固定下颈椎时,采用经关节螺钉联合侧块螺钉或椎弓根螺钉固定,均可取得较好的固定效果.