Li Jie, Zhao Liujun, Liu Wangmi, Ma Weihu, Xu Rongming, Jiang Wei-Yu, Gu Yongjie, Lu Liangjie, Yu Liang, Qi Feng
Department of Orthopaedic Surgery, Ningbo Medical centre, Li Huili hospital, 57 Xingning Road, Ningbo, 315040, Zhejiang, China.
Eur Spine J. 2015 Aug;24(8):1681-90. doi: 10.1007/s00586-015-3808-2. Epub 2015 Feb 20.
This study aimed at exploring the clinical application of anterior transpedicular screw (ATPS) and plate in the reconstruction of subaxial cervical spine.
8 cases were reconstructed by ATPS and plate in the subaxial cervical spine from Jan 2009 to Dec 2011. X-rays and computed tomography images were collected to evaluate the position of ATPS. Magnetic resonance imaging was also included to evaluate the result of decompression, the existence of epidural hematoma and the morphology of the cervical spinal cord. Japanese Orthopaedic Association scores were observed before and after operation as a functional estimation.
All of the eight cases were followed up from 3 to 36 months with the average of 15.5 months. A total of 16 ATPS were implanted in the subaxial cervical spine in the eight patients. All the screws were inserted smoothly. Bone fusion was found in all the subjects 4.5 months after operation on average. No loosening or breakage of the internal fixation was observed in our study. Hoarseness was observed in one case due to distraction injury of the recurrent laryngeal nerve, which disappeared after 3 weeks' conservative treatment. Dysphagia was complained by two patients after surgery, which was alleviated 3 months later. There were four screws deviating less than 1 mm (Grade 1), two medially and two laterally. All the anterior compressions were removed completely in this group. Only a small amount of epidural hematoma was found in four cases on MRI images before discharge. The average JOA scores were significantly improved from 5.6 ± 1.4 before surgery to 14.5 ± 0.8 at discharge (P < 0.01), which decreased to 13.2 ± 1.2 at 3 months after operation, but improved again to 15.2 ± 0.8 at 1 year after operation.
Although there are some complications, ATPS with plate is an effective and safe technique for anterior reconstruction in the subaxial cervical spine. Only those spine centers with sufficient experience in complex cervical spine reconstruction surgery can conduct this technique according to strict indications.
本研究旨在探讨颈椎前路椎弓根螺钉（ATPS）及钢板在下颈椎重建中的临床应用。
2009年1月至2011年12月，对8例下颈椎患者采用ATPS及钢板进行重建。收集X线及计算机断层扫描图像以评估ATPS的位置。还包括磁共振成像以评估减压效果、硬膜外血肿的存在及颈脊髓形态。观察术前及术后日本骨科协会评分作为功能评估。
8例患者均获随访，时间3至36个月，平均15.5个月。8例患者在下颈椎共植入16枚ATPS。所有螺钉均顺利置入。平均术后4.5个月所有患者均发现骨融合。本研究中未观察到内固定松动或断裂。1例因喉返神经牵拉伤出现声音嘶哑，经3周保守治疗后消失。2例患者术后出现吞咽困难，3个月后缓解。有4枚螺钉偏差小于1mm（1级），2枚向内侧、2枚向外侧。该组所有前路压迫均完全解除。出院前MRI图像上4例仅发现少量硬膜外血肿。日本骨科协会平均评分术前为5.6±1.4，出院时显著提高至14.5±0.8（P<0.01），术后3个月降至13.2±1.2，但术后1年再次提高至15.2±0.8。
尽管存在一些并发症，但ATPS联合钢板是下颈椎前路重建的一种有效且安全的技术。只有在复杂颈椎重建手术方面有足够经验的脊柱中心才能根据严格指征开展该技术。
