Kwon Brian K, Vaccaro Alexander R, Grauer Jonathan N, Beiner John M
Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
Neurosurgery. 2007 Jan;60(1 Supp1 1):S118-29. doi: 10.1227/01.NEU.0000249222.57709.59.
In the surgical management of cervical spondylosis, the application of rigid internal fixation can enhance the immediate stability of the cervical spine. The sophistication of such internal fixation systems and the indications for their use are continuously evolving. A sound understanding of regional anatomy, biomechanics, and kinematics within the cervical spine is essential for the safe and effective application of internal fixation. Numerous options currently exist for anterior cervical plating systems; some lock the screws to the plate rigidly (constrained), whereas others allow for some rotational or translational motion between the screw and plate (semiconstrained). The role of anterior fixation in single and multilevel fusions is still the subject of some controversy. Long anterior cervical reconstructions may require additional posterior fixation to reliably promote fusion. Rigid fixation in the posterior cervical spine can be achieved with lateral mass screws or pedicle screws. Although lateral mass screws provide excellent fixation within the subaxial cervical spine, the regional anatomy of C2 and C7 often make it difficult to place such screws, and pedicle screws at these levels are advocated. Pedicle screws achieve fixation into both the anterior and posterior column and are arguably the most stable form of rigid internal fixation within the cervical spine. Familiarity with these internal fixation techniques can be an extremely valuable tool for the spine surgeon managing these degenerative disorders of the cervical spine.
在颈椎病的外科治疗中，应用坚固内固定可增强颈椎的即刻稳定性。此类内固定系统的复杂性及其使用指征在不断发展。深入了解颈椎区域的解剖结构、生物力学和运动学对于安全有效地应用内固定至关重要。目前，颈椎前路钢板系统有多种选择；有些将螺钉牢固锁定于钢板（限制型），而另一些则允许螺钉与钢板之间存在一定的旋转或平移运动（半限制型）。前路固定在单节段和多节段融合中的作用仍存在一些争议。长节段颈椎前路重建可能需要额外的后路固定以可靠地促进融合。颈椎后路的坚固固定可通过侧块螺钉或椎弓根螺钉实现。尽管侧块螺钉在颈椎下颈椎节段提供了良好的固定，但C2和C7的局部解剖结构常常使放置此类螺钉变得困难，因此提倡在这些节段使用椎弓根螺钉。椎弓根螺钉可实现对前后柱的固定，堪称颈椎内最稳定的坚固内固定形式。熟悉这些内固定技术对于脊柱外科医生处理颈椎这些退行性疾病而言是一项极其宝贵的工具。
