Garrido Ben J, Puschak Thomas J, Anderson Paul A, Sasso Rick C
Indiana Spine Group, Indianapolis, IN 46202, USA.
Orthopedics. 2009 Oct;32(10). doi: 10.3928/01477447-20090818-11.
Stabilization of the occipitocervical junction and fixation of the occiput is challenging. Rigid fixation with plates and screws has reduced dependence on external immobilization and improved fusion rates. The strength of the occipital fixation can be compromised as plates constrain the ability to place occipital screws along the midline. Bilateral contoured rods with medial offset connectors allow placement of 6 occipital screws in the thickest and strongest bone along the midline, while easily connecting to screws in the cervical spine. The purpose of this study is to review complications and fusion rates in a patient series using this new technique to stabilize the occipitocervical junction. A retrospective review was performed at 2 years of 20 patients who underwent occipitocervical fusion for instability using bilateral contoured rods with medial offset connectors. Six occipital screws were successfully placed in 17 patients. The caudal screw on one side was abandoned in 3 patients due to insufficient occipital thickness. Sixteen patients fused. Four patients died in the perioperative period secondary to polytrauma complications. There were no hardware-related complications nor failure of occipital fixation. Bilateral rods with medial offset connectors allow parasagittal placement of 6 bicortical screws in the thickest and strongest bone along the occipital midline. The use of 6 occipital screws has been shown to be biomechanically advantageous. Using this technique, 6 occipital screws were easily placed in each of 17 patients, while 5 strong points of fixation were obtained in the other 3 patients. We experienced no failure of occipital fixation, and all surviving patients went on to fusion.
枕颈关节的稳定和枕骨的固定具有挑战性。使用钢板和螺钉进行刚性固定减少了对外部固定的依赖并提高了融合率。由于钢板限制了沿中线放置枕骨螺钉的能力，枕骨固定的强度可能会受到影响。带有内侧偏移连接器的双侧塑形棒允许在沿中线最厚且最强壮的骨中放置6枚枕骨螺钉，同时可轻松连接至颈椎螺钉。本研究的目的是回顾使用这种新技术稳定枕颈关节的患者系列中的并发症和融合率。对20例使用带有内侧偏移连接器的双侧塑形棒进行枕颈融合以治疗不稳的患者进行了2年的回顾性研究。17例患者成功置入了6枚枕骨螺钉。3例患者因枕骨厚度不足而放弃了一侧的尾侧螺钉。16例患者实现了融合。4例患者在围手术期因多发伤并发症死亡。没有与硬件相关的并发症，也没有枕骨固定失败的情况。带有内侧偏移连接器的双侧棒允许在沿枕骨中线最厚且最强壮的骨中矢状旁放置6枚双皮质螺钉。已证明使用6枚枕骨螺钉在生物力学上具有优势。使用该技术，17例患者中的每例都轻松置入了6枚枕骨螺钉，而其他3例患者获得了5个牢固的固定点。我们没有遇到枕骨固定失败的情况，所有存活患者均实现了融合。
