枢椎椎板螺钉在儿童颅颈交界区手术中使用的临床疗效
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摘要
目的探讨枢椎(C_2)椎板螺钉在儿童颅颈交界区手术中使用的临床疗效。方法回顾性分析2009年9月至2016年8月在我院采用C_2椎板螺钉治疗的12例儿童颅颈交界区患者资料,其中男8例,女4例;年龄2～14岁,平均8.2岁。临床症状主要表现为枕颈部疼痛、肢体无力、麻木等,8例患儿有高位颈脊髓病表现。术前行颈椎正侧位和过伸过屈位X线、寰枢椎薄层CT、颈椎MRI和椎动脉CTA检查。采用日本矫形外科学会的(Japanese orthopaedic association scores,JOA)评分系统评价手术前后脊髓功能改善情况,术前平均为13.3分。结果本组12例患者均获随访,随访时间6～20个月,平均10个月;寰枢椎固定7例,枕颈固定5例。7例C_2采用了双侧椎板钉,5例为单侧椎板钉和对侧椎弓根钉。术前存在神经功能损害的8例患者有2例遗留右手握力下降(肌力4级),1例遗留左上肢灵活性下降,其余完全恢复。末次随访的JOA评分平均为15.8分。结论在C_2椎弓根不适合置钉的儿童患者中,使用C_2椎板螺钉固定的近期疗效肯定。
Objective To investigate the clinical effects of using axial laminar screw in the operation of craniocervical junction in pediatric population.Methods From September 2009 to August 2016,12 pediatric patients who underwent axial laminar screwwere retrospectively analyzed.There were 8 males and 4 females with an average age of 8.2 years old(range 2～14).The main manifestations were neck pain,limb weakness and numbness.8 cases hadupper cervical myelopathy.Preoperative imaging examination was performed to clear the spinal cordinjury and vertebral artery variability.The spinal cord function was evaluated by JOA scoring system.The average of preoperative JOA score was 13.3.Results All the 12 cases were followed up for 6 to 20 months(mean 10 months).Atlantoaxialfixation was performed in 7 cases and occipital cervical fixation in 5 cases.Among them,7 cases were treated with bilateral laminar screw and 5 cases with unilateral pedicle screw combined with pedicle screw fixation.No spinal nerve or vertebral artery injury was found.All cases had bony fusion.All 8 patients with preoperative neurological impairment had all the sensory abnormalities recovered,6 patients had normal muscle strength after operation,2 left hand grip strength decreased(grade 4),and 1 left lower limb flexibility decreased.The JOA score at the last follow-up was 15.8.Conclusion In pediatric patients who are not suitable for pedicle screw placement,the short-term curative effect of laminar screw fixation is reliable.
Objective To investigate the clinical effects of using axial laminar screw in the operation of craniocervical junction in pediatric population.Methods From September 2009 to August 2016,12 pediatric patients who underwent axial laminar screwwere retrospectively analyzed.There were 8 males and 4 females with an average age of 8.2 years old(range 2～14).The main manifestations were neck pain,limb weakness and numbness.8 cases hadupper cervical myelopathy.Preoperative imaging examination was performed to clear the spinal cordinjury and vertebral artery variability.The spinal cord function was evaluated by JOA scoring system.The average of preoperative JOA score was 13.3.Results All the 12 cases were followed up for 6 to 20 months(mean 10 months).Atlantoaxialfixation was performed in 7 cases and occipital cervical fixation in 5 cases.Among them,7 cases were treated with bilateral laminar screw and 5 cases with unilateral pedicle screw combined with pedicle screw fixation.No spinal nerve or vertebral artery injury was found.All cases had bony fusion.All 8 patients with preoperative neurological impairment had all the sensory abnormalities recovered,6 patients had normal muscle strength after operation,2 left hand grip strength decreased(grade 4),and 1 left lower limb flexibility decreased.The JOA score at the last follow-up was 15.8.Conclusion In pediatric patients who are not suitable for pedicle screw placement,the short-term curative effect of laminar screw fixation is reliable.
引文
[1]Ma W,Feng L,Xu R,et al.Clinical application of C2laminar screw technique[J].Eur Spine J,2010,19(8):1312-1317.
[2]Gabriel JP,Muzumdar AM,Khalil S,et al.A novel crossedrod configuration incorporating translaminar screws for occipitocer-vical internal fixation:an in vitro biomechanical study[J].Spine J,2011,11(1):30-35.
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[5]Xinjie W,Yafeng L,Mingsheng T,et al.Long-term clinical and radiologic postoperative outcomes after C1~C2Pedicle screw techniques for pediatric atlantoaxial rotatory dislocation[J].World Neurosurg,2018,112(6):404-421.
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[7]薛文,刘林,管晓鹂,等.不同直径螺钉固定儿童枢椎椎弓根和椎板的可行性研究[J].中华创伤骨科杂志,2011,13(10):940-942.
[8]Wright NM.Posterior C2 fixation using bilateral,crossing C2laminar screws:case series and technical note[J].J Spinal Disord Tech,2004,17(2):158-162.
[9]Ferri-de-Barros F,Little DG,Bridge C,et al.Atlantoaxial and craniocervical arthrodesis in children.Atomographicstudy comparing suitability of C2 pedicles and C2 laminar for screwfixation[J].Spine,2010,35(3):291-293.
[10]Dmitriev AE,Lehman RA Jr,Helgeson MD,et al.A-cute and long-term stability of atlantoaxial fixation methods:a biomechanical comparison of pars,pedicle,and intralaminar fixation in an intact and odontoid fracture model[J].Spine(Phila Pa 1976),2009,34(4):365-370.
[11]Du JY,Aichmair A,Kueper J,et al.Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers:a systematic review and meta-analysis[J].J Neurosurg Spine,2015,22(2):151-161.
[12]Kuroki H,Kubo S,Hamnaka H,et al.Posterior occipito-axial fixation applied C2 laminar screws for pediatric atlantoaxial instability caused by down syndrome:report of 2cases[J].Int J Spine Surg,2012,12(6):210-215.
[13]Ma X,Peng X,Xiang Y,et al.A finite element modeling of posterior atlantoaxial fixation and biomechanical analysis of C2intralaminar screw fixation[J].Chin Med J(Engl),2014,127(7):1266-1271.
[14]马向阳,杨进城,邱锋,等.寰枢椎脱位后路植骨材料的选择与融合效果评价[J].中国骨科临床与基础研究杂志,2015,7(1):5-9.
[15]Elliott RE,Tanweer O,Boah A.et al.Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs:meta-analysis and review of literature[J].J Spinal Disord Tech,2014,27(1):11-28.
[16]Reintjes SL,Amankwah EK,Rodriguez LF,et al.Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion:a systematic review of factors affecting fusion rates[J].J Neurosurg Pediatr,2016,17(2):187-202.
[17]高志朝,王梅,王大勇,等.后路寰枢椎椎弓根螺钉结合单侧枢椎棘突椎板钉固定治疗寰枢椎不稳的临床疗效[J].中华骨科杂志,2015,35(5):503-510.
[2]Gabriel JP,Muzumdar AM,Khalil S,et al.A novel crossedrod configuration incorporating translaminar screws for occipitocer-vical internal fixation:an in vitro biomechanical study[J].Spine J,2011,11(1):30-35.
[3]夏虹,艾福志,王建华,等.寰枢椎椎弓根螺钉固定在儿童上颈椎疾患中的应用[J].中国骨科临床与基础研究杂志,2010,2(3):181-185.
[4]Zhang YH,Shao J,Chou D,et al.C1~C2 pedicle screw fixation for atlantoaxial dislocation in pediatric patients youngerthan 5years:a case series of 15patients[J].WorldNeurosurg,2017,108(12):498-505.
[5]Xinjie W,Yafeng L,Mingsheng T,et al.Long-term clinical and radiologic postoperative outcomes after C1~C2Pedicle screw techniques for pediatric atlantoaxial rotatory dislocation[J].World Neurosurg,2018,112(6):404-421.
[6]Chern J,Chamoun RB,Whitehead WE,et al.Computed tomography morphometric analysis for axial andsubaxial translaminar screw placement in the pediatric cervical spine[J].J Neurosurg Pediatr,2009,3(2):121-128.
[7]薛文,刘林,管晓鹂,等.不同直径螺钉固定儿童枢椎椎弓根和椎板的可行性研究[J].中华创伤骨科杂志,2011,13(10):940-942.
[8]Wright NM.Posterior C2 fixation using bilateral,crossing C2laminar screws:case series and technical note[J].J Spinal Disord Tech,2004,17(2):158-162.
[9]Ferri-de-Barros F,Little DG,Bridge C,et al.Atlantoaxial and craniocervical arthrodesis in children.Atomographicstudy comparing suitability of C2 pedicles and C2 laminar for screwfixation[J].Spine,2010,35(3):291-293.
[10]Dmitriev AE,Lehman RA Jr,Helgeson MD,et al.A-cute and long-term stability of atlantoaxial fixation methods:a biomechanical comparison of pars,pedicle,and intralaminar fixation in an intact and odontoid fracture model[J].Spine(Phila Pa 1976),2009,34(4):365-370.
[11]Du JY,Aichmair A,Kueper J,et al.Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers:a systematic review and meta-analysis[J].J Neurosurg Spine,2015,22(2):151-161.
[12]Kuroki H,Kubo S,Hamnaka H,et al.Posterior occipito-axial fixation applied C2 laminar screws for pediatric atlantoaxial instability caused by down syndrome:report of 2cases[J].Int J Spine Surg,2012,12(6):210-215.
[13]Ma X,Peng X,Xiang Y,et al.A finite element modeling of posterior atlantoaxial fixation and biomechanical analysis of C2intralaminar screw fixation[J].Chin Med J(Engl),2014,127(7):1266-1271.
[14]马向阳,杨进城,邱锋,等.寰枢椎脱位后路植骨材料的选择与融合效果评价[J].中国骨科临床与基础研究杂志,2015,7(1):5-9.
[15]Elliott RE,Tanweer O,Boah A.et al.Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs:meta-analysis and review of literature[J].J Spinal Disord Tech,2014,27(1):11-28.
[16]Reintjes SL,Amankwah EK,Rodriguez LF,et al.Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion:a systematic review of factors affecting fusion rates[J].J Neurosurg Pediatr,2016,17(2):187-202.
[17]高志朝,王梅,王大勇,等.后路寰枢椎椎弓根螺钉结合单侧枢椎棘突椎板钉固定治疗寰枢椎不稳的临床疗效[J].中华骨科杂志,2015,35(5):503-510.