Hedequist Daniel J, Emans John B
From the Department of Orthopedic Surgery, Children's Hospital, Harvard Medical School, Boston, MA.
J Am Acad Orthop Surg. 2016 Jun;24(6):370-8. doi: 10.5435/JAAOS-D-15-00199.
Instrumentation of the cervical spine enhances stability and improves arthrodesis rates in children undergoing surgery for deformity or instability. Various morphologic and clinical studies have been conducted in children, confirming the feasibility of anterior or posterior instrumentation of the cervical spine with modern implants. Knowledge of the relevant spine anatomy and preoperative imaging studies can aid the clinician in understanding the pitfalls of instrumentation for each patient. Preoperative planning, intraoperative positioning, and adherence to strict surgical techniques are required given the small size of children. Instrumentation options include anterior plating, occipital plating, and a variety of posterior screw techniques. Complications related to screw malposition include injury to the vertebral artery, neurologic injury, and instrumentation failure.
颈椎内固定可增强稳定性，并提高接受畸形或不稳定手术的儿童的关节融合率。已对儿童进行了各种形态学和临床研究，证实了使用现代植入物对颈椎进行前路或后路内固定的可行性。了解相关脊柱解剖结构和术前影像学研究有助于临床医生理解每位患者内固定的陷阱。鉴于儿童体型较小，需要进行术前规划、术中定位并严格遵守手术技术。内固定选择包括前路钢板固定、枕骨钢板固定以及多种后路螺钉技术。与螺钉位置不当相关的并发症包括椎动脉损伤、神经损伤和内固定失败。
